Healthcare Provider Details

I. General information

NPI: 1336254978
Provider Name (Legal Business Name): JOHN T LANGFITT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/05/2023
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

PO BOX 278984
ROCHESTER NY
14627-8984
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7420
  • Fax: 585-756-2311
Mailing address:
  • Phone: 585-341-7420
  • Fax: 585-756-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number010929
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number10929
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: