Healthcare Provider Details

I. General information

NPI: 1124702683
Provider Name (Legal Business Name): LAN PENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROSEMONT AVE
FARMINGVILLE NY
11738-2047
US

IV. Provider business mailing address

133 ROSEMONT AVE
FARMINGVILLE NY
11738-2047
US

V. Phone/Fax

Practice location:
  • Phone: 347-254-4274
  • Fax:
Mailing address:
  • Phone: 347-254-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: