Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD00317100 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00317100 | NJ |
NPI | 1245677855 |
---|---|
Provider Name | Dr. Kenya A Lazovik |
First Address | Cliffside Park, NJ 07010-1721 |
Second Address | Cliffside Park, NJ 07010-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2013 |
Last Update Date | 24/06/2021 |