Healthcare Provider Details

I. General information

NPI: 1063672327
Provider Name (Legal Business Name): EDWARD LANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 07/07/2011
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

PO BOX 7764
METAIRIE LA
70010-7764
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 TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD092R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD092R
License Number StateLA

VIII. Authorized Official

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