Provider Demographics
NPI:1285787465
Name:LAZOS, ERNEST ANASTASIOS (DPM)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:ANASTASIOS
Last Name:LAZOS
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 1:2301 EVESHAM RD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-772-2979
Mailing Address - Fax:856-770-1192
Practice Address - Street 1:2301 EVESHAM RD
Practice Address - Street 2:SUITE 507
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-772-2979
Practice Address - Fax:856-770-1192
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01805213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4787901Medicaid
NJ4787901Medicaid
T96088Medicare UPIN