Healthcare Provider Details

I. General information

NPI: 1831459080
Provider Name (Legal Business Name): JOANNE SYLVIA LANE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 HIGH ST
BURLINGTON NJ
08016-2737
US

IV. Provider business mailing address

1 N WHITE HORSE PIKE
HAMMONTON NJ
08037-1875
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-0775
  • Fax: 609-386-4372
Mailing address:
  • Phone: 609-567-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB11177000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102204108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: