Provider Demographics
NPI:1447425590
Name:RONALD J. LANCZ,DPM P.A.
Entity Type:Organization
Organization Name:RONALD J. LANCZ,DPM P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANCZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-364-4300
Mailing Address - Street 1:721 W KENNEDY BLVD
Mailing Address - Street 2:SUITE B5
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1255
Mailing Address - Country:US
Mailing Address - Phone:732-364-4300
Mailing Address - Fax:732-886-7363
Practice Address - Street 1:721 W KENNEDY BLVD
Practice Address - Street 2:SUITE B5
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1255
Practice Address - Country:US
Practice Address - Phone:732-364-4300
Practice Address - Fax:732-886-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002201213E00000X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5535204Medicaid
NJ5535204Medicaid
NJ195498Medicare PIN
NJ5732060001Medicare NSC