MEDICARE: DR. JOHN J LEN MD

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	208D00000X	General Practice Physician	109395	NY

General Provider Information

NPI Number	:	1912987496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J LEN MD

Provider Business Mailing Address
First Line	:	64 HOWARD ST
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-3004
Country	:	US
Telephone Number	:	518-237-7345
Fax Number	:	518-237-4997

Provider Business Practice Location Address
First Line	:	64 HOWARD ST
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-3004
Country	:	US
Telephone Number	:	518-237-7345
Fax Number	:	518-237-4997

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/07/2016

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