Provider Demographics
NPI:1619954302
Name:LANCZ, RONALD J (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:LANCZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RIVER AVE
Mailing Address - Street 2:BUILDING B SUITE #303
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4267
Mailing Address - Country:US
Mailing Address - Phone:732-364-4300
Mailing Address - Fax:732-886-7363
Practice Address - Street 1:105 RIVER AVENUE
Practice Address - Street 2:BUILDING B SUITE #303
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-364-4300
Practice Address - Fax:732-886-7363
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002201213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K5078OtherPHS GUARDIAN
NJ5535204Medicaid
P2098264OtherOXFORD
195498Medicare PIN
P2098264OtherOXFORD