MEDICARE: DR KENYA LAZOVIK

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	213EP1101X	Primary Podiatric Medicine Podiatrist
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1780254003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KENYA LAZOVIK

Provider Business Mailing Address
First Line	:	4 HUNTER ST STE 201
Second Line	:
City	:	LODI
State	:	NJ
Zip	:	07644-1608
Country	:	US
Telephone Number	:	862-233-8438
Fax Number	:	201-945-4650

Provider Business Practice Location Address
First Line	:	4 HUNTER ST STE 201
Second Line	:
City	:	LODI
State	:	NJ
Zip	:	07644-1608
Country	:	US
Telephone Number	:	862-233-8438
Fax Number	:	201-945-4650

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENYA LAZOVIK
Credential	:	DPM
Telephone Number	:	201-943-7977

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	04/07/2022

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Directions to “DR KENYA LAZOVIK ” Practice Location

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