Individual
JEREMY DANIEL LAZORKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
45 BELLEFONTE AVE, SUITE #2, LOCK HAVEN, PA 17745
(570) 858-5328
(570) 858-5355
Mailing address
45 BELLEFONTE AVE, SUITE #2, LOCK HAVEN, PA 17745-1237
(570) 858-5328
(570) 858-5355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA055552
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103271986-0004
—
PA
01
—
6Z2639
MEDICARE PTAN
PA
Enumeration date
06/25/2012
Last updated
11/01/2024
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