Healthcare Provider Details

I. General information

NPI: 1063646313
Provider Name (Legal Business Name): RUSSELL LANGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS ROAD SAINT BARNABAS MEDICAL CENTER DEPARTMENT OF SURGERY
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

DEPARTMENT OF SURGERY 94 OLD SHORT HILLS ROAD
LIVINGSTON NJ
07039-5672
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5995
  • Fax:
Mailing address:
  • Phone: 917-922-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA10099400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: