Healthcare Provider Details

I. General information

NPI: 1083008270
Provider Name (Legal Business Name): JACLYN D LOZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN DY

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DR STE 210
BENNINGTON VT
05201
US

IV. Provider business mailing address

201 LYONS AVE
NEWARK NJ
07112-2027
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-3930
  • Fax: 802-447-8539
Mailing address:
  • Phone: 973-926-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0014123
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: