Provider Demographics
NPI:1134640972
Name:LASOCHA, PAWEL
Entity Type:Individual
Prefix:
First Name:PAWEL
Middle Name:
Last Name:LASOCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 BLEECKER ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1939
Mailing Address - Country:US
Mailing Address - Phone:347-221-8412
Mailing Address - Fax:
Practice Address - Street 1:165 ERIE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1717
Practice Address - Country:US
Practice Address - Phone:201-963-1903
Practice Address - Fax:201-222-6534
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2017-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03795100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist