Provider Demographics
NPI:1376518407
Name:LANZA, RAYMOND (DO, FACP, CMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:LANZA
Suffix:
Gender:M
Credentials:DO, FACP, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 KING GEORGE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5120
Mailing Address - Country:US
Mailing Address - Phone:732-893-8150
Mailing Address - Fax:732-893-8149
Practice Address - Street 1:266 KING GEORGE RD
Practice Address - Street 2:SUITE F
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5120
Practice Address - Country:US
Practice Address - Phone:732-893-8149
Practice Address - Fax:732-893-8149
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MB03658300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
222382062OtherTAX ID NUMBER
NJ445050Medicare PIN
222382062OtherTAX ID NUMBER