Provider Demographics
NPI:1699750653
Name:LAKRITZ, PHILIP SHEV (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:SHEV
Last Name:LAKRITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:264 AMBOY AVE
Practice Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2441
Practice Address - Country:US
Practice Address - Phone:732-548-2322
Practice Address - Fax:732-548-3392
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-01-04
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064597002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197166Medicaid
NJ7418809Medicaid
NY02197166Medicaid
NJ901505Medicare ID - Type Unspecified