Individual
DR. JASON HOWARD LIZZACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
17-10 RIVER RD STE 4B, FAIR LAWN, NJ 07410-1250
(201) 797-7774
(201) 797-0740
Mailing address
17-10 RIVER RD STE 4B, FAIR LAWN, NJ 07410-1250
(201) 797-7774
(201) 797-0740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
051014
NY
1223G0001X
General Practice Dentistry
Primary
22DI02166400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02556921
—
NY
Enumeration date
01/01/2007
Last updated
07/09/2007
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