Healthcare Provider Details

I. General information

NPI: 1073646956
Provider Name (Legal Business Name): ELIZABETH LANZA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GOFFLE RD
RIDGEWOOD NJ
07450-4027
US

IV. Provider business mailing address

51 MERRILL DR
MAHWAH NJ
07430-2973
US

V. Phone/Fax

Practice location:
  • Phone: 201-612-1006
  • Fax:
Mailing address:
  • Phone: 201-848-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number41YA00017300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: