MEDICARE: MR. MATTHEW WILLIAM LEZZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	26NR17765400	NJ
2	367500000X	Certified Registered Nurse Anesthetist	673274-1	NY
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477040855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW WILLIAM LEZZO

Provider Business Mailing Address
First Line	:	30 BIRMINGHAM DR
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-3543
Country	:	US
Telephone Number	:	732-850-6368
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 ROUTE 33
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753
Country	:	US
Telephone Number	:	732-775-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	12/22/2025

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