MEDICARE: ELIZABETH ANN LANG MED BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598119430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN LANG MED BCBA

Provider Business Mailing Address
First Line	:	202 S 3RD ST
Second Line	:	SUITE 2
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-2150
Country	:	US
Telephone Number	:	484-935-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 S 3RD ST
Second Line	:	SUITE 2
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-2150
Country	:	US
Telephone Number	:	484-935-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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