Healthcare Provider Details

I. General information

NPI: 1053870782
Provider Name (Legal Business Name): A PROFESSIONAL PODIATRY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 JENA ST
NEW ORLEANS LA
70115-6325
US

IV. Provider business mailing address

2626 JENA ST
NEW ORLEANS LA
70115-6325
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-3627
  • Fax: 504-897-3339
Mailing address:
  • Phone: 504-897-3627
  • Fax: 504-897-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD LANG
Title or Position: OWNER
Credential:
Phone: 504-897-3627