Provider Demographics
NPI:1932148533
Name:LANZILOTTA, MICHAEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:LANZILOTTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9234
Mailing Address - Country:US
Mailing Address - Phone:609-654-1330
Mailing Address - Fax:609-714-1612
Practice Address - Street 1:133 JACKSON RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9234
Practice Address - Country:US
Practice Address - Phone:609-654-1330
Practice Address - Fax:609-714-1612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00557400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037978Medicare PIN