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Individual

MR. LIONEL DIAZ FOZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
525 JACK MARTIN BLVD, SUTE 102, BRICK, NJ 08724
(732) 458-1177
(732) 458-5942
Mailing address
525 JACK MARTIN BLVD, SUTE 102, BRICK, NJ 08724
(732) 458-1177
(732) 458-5942

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA0243
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011865
AETNA
01
1077540
MERCEY / STATE PLAN
01
J0912
BLUE CROSS / HMO
Enumeration date
10/16/2006
Last updated
07/08/2007
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