=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285520932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDY LEE LANE LIC. AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 83 MILL HILL RD
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12498-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-594-3966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1671 ROUTE 212
-----------------------------------------------------
City | SAUGERTIES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12477-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-741-0098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 007669-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------