Healthcare Provider Details

I. General information

NPI: 1124729405
Provider Name (Legal Business Name): LANGE NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800A 5TH AVE STE 203
NEW YORK NY
10065-7215
US

IV. Provider business mailing address

800A 5TH AVE STE 203
NEW YORK NY
10065-7215
US

V. Phone/Fax

Practice location:
  • Phone: 332-334-6637
  • Fax:
Mailing address:
  • Phone: 332-334-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALE JOSEPH LANGE
Title or Position: PRESIDENT
Credential: MD
Phone: 332-334-6637