Provider Demographics
NPI:1255421582
Name:FOZ, LIONEL DIAZ (MD)
Entity type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:DIAZ
Last Name:FOZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:525 JACK MARTIN BLVD
Mailing Address - Street 2:SUTE 102
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-458-1177
Mailing Address - Fax:732-458-5942
Practice Address - Street 1:525 JACK MARTIN BLVD
Practice Address - Street 2:SUTE 102
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-1177
Practice Address - Fax:732-458-5942
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA0243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
011865OtherAETNA
1077540OtherMERCEY / STATE PLAN
J0912OtherBLUE CROSS / HMO