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General NPI Number Information
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NPI Number | 1316081581
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Entity Type | Individual
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Provider Name | DR. DEREK LEZAMA
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5455 KINGS HWY
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City | BROOKLYN
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State | NY
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Zip | 11203-6040
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Country | US
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Telephone | 718-629-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 5455 KINGS HWY
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City | BROOKLYN
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State | NY
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Zip | 11203-6040
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Country | US
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Telephone | 718-629-4020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 007667
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License Number State | NY
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