Healthcare Provider Details

I. General information

NPI: 1306828447
Provider Name (Legal Business Name): LAN WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 W PARKWAY
POMPTON PLAINS NJ
07444-1647
US

IV. Provider business mailing address

PO BOX 144333
ORLANDO FL
32814-4333
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-5046
  • Fax: 973-831-5194
Mailing address:
  • Phone: 407-422-9831
  • Fax: 407-648-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA07786900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number216751
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: