Healthcare Provider Details

I. General information

NPI: 1174722276
Provider Name (Legal Business Name): MARIANNE LANTS DPM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 HUGUENOT AVE
STATEN ISLAND NY
10312-4315
US

IV. Provider business mailing address

208 HOLTON AVE
STATEN ISLAND NY
10309-3739
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-3838
  • Fax:
Mailing address:
  • Phone: 347-256-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006191
License Number StateNY

VIII. Authorized Official

Name: DR. MARIANNE LANTS
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 347-256-6732