Provider Demographics
NPI:1245677855
Name:LAZOVIK, KENYA A (DPM)
Entity type:Individual
Prefix:DR
First Name:KENYA
Middle Name:A
Last Name:LAZOVIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KENYA
Other - Middle Name:A
Other - Last Name:WILTSIE / ROSENMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:542 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1721
Mailing Address - Country:US
Mailing Address - Phone:201-943-7977
Mailing Address - Fax:201-945-4650
Practice Address - Street 1:542 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1721
Practice Address - Country:US
Practice Address - Phone:201-943-7977
Practice Address - Fax:201-945-4650
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00317100213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ294782ZE22Medicare PIN