Lizzack, Jason Howard

Lizzack, Jason Howard is an sole proprietor health care provider with primary practice located at 17-10 River Rd Ste 4B , Fair Lawn NJ 07410-1250. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Lizzack, Jason Howard can be contacted via phone (201) 797-7774.

Contact Information

Primary practice address
17-10 River Rd Ste 4B Fair Lawn NJ 07410-1250
Phone: (201) 797-7774
Fax: (201) 797-0740
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 051014 New York
Dental Providers / General Practice 1223G0001X 22DI02166400 New Jersey

Profile Details

NPI number 1407912538
LBN Legal business name Lizzack, Jason Howard
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 1st, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407912538 NPPES
New York MEDICAID 02556921

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