Provider Demographics
NPI:1861414385
Name:LEZAMIZ, JOSEPH I (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:LEZAMIZ
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 1:15144 82ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1777
Mailing Address - Country:US
Mailing Address - Phone:718-738-2550
Mailing Address - Fax:718-738-6644
Practice Address - Street 1:15144 82ND ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1777
Practice Address - Country:US
Practice Address - Phone:718-738-2550
Practice Address - Fax:718-738-6644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006507111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78932Medicare ID - Type UnspecifiedGHI MEDICARE
NYU11761Medicare UPIN