=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255788634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH M LANDER REALTY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2016
-----------------------------------------------------
Last Update Date | 05/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 WASHINGTON ST
-----------------------------------------------------
City | GLOVERSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12078-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-725-6780
-----------------------------------------------------
Fax | 518-725-5050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 WASHINGTON ST
-----------------------------------------------------
City | GLOVERSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12078-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-725-6780
-----------------------------------------------------
Fax | 518-725-5050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. SHEILA L LANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-725-6780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------