Healthcare Provider Details

I. General information

NPI: 1609857010
Provider Name (Legal Business Name): MARCELO E LANCMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WESTCHESTER AVE STE E104
WHITE PLAINS NY
10604-2930
US

IV. Provider business mailing address

333 WESTCHESTER AVE STE E104
WHITE PLAINS NY
10604-2930
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-3651
  • Fax: 914-428-2948
Mailing address:
  • Phone: 914-428-3651
  • Fax: 914-428-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number67336
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number67336
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number040449
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number209238
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number0101280594
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number209238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: