Healthcare Provider Details

I. General information

NPI: 1033344155
Provider Name (Legal Business Name): BERNARD J LANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

100 PORT WASHINGTON BLVD NEW YORK CARDIOVASCULAR ANESTHESIOLOGISTS, PC
ROSLYN NY
11576-1347
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-6624
  • Fax: 516-627-3804
Mailing address:
  • Phone: 516-627-6624
  • Fax: 516-627-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT195313
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT195313
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09761700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: