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General NPI Number Information
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NPI Number | 1134592801
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Entity Type | Organization
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Legal Business Name | MO LAN MEDICINE P.C
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 13304 41ST AVE SUITE 1B
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City | FLUSHING
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State | NY
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Zip | 11355-5856
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Country | US
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Telephone | 718-666-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 13304 41ST AVE SUITE 1B
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City | FLUSHING
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State | NY
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Zip | 11355-5856
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Country | US
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Telephone | 718-666-5058
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. LAN MO
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Credential |
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Telephone | 718-666-5058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 262717
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License Number State | NY
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