Healthcare Provider Details

I. General information

NPI: 1164318333
Provider Name (Legal Business Name): DAVID LANG CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BON AIRE CIR W
SUFFERN NY
10901-7010
US

IV. Provider business mailing address

113 BON AIRE CIR W
SUFFERN NY
10901-7010
US

V. Phone/Fax

Practice location:
  • Phone: 845-293-5628
  • Fax:
Mailing address:
  • Phone: 845-293-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number40038
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number369013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: