Healthcare Provider Details

I. General information

NPI: 1912987496
Provider Name (Legal Business Name): JOHN J LEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 HOWARD ST
COHOES NY
12047-3004
US

IV. Provider business mailing address

64 HOWARD ST
COHOES NY
12047-3004
US

V. Phone/Fax

Practice location:
  • Phone: 518-237-7345
  • Fax: 518-237-4997
Mailing address:
  • Phone: 518-237-7345
  • Fax: 518-237-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number109395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: