=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639122765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANGER PROFESSIONAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 COMMACK RD
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11729-4514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-667-1200
-----------------------------------------------------
Fax | 631-254-2320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 COMMACK RD
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11729-4514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-667-1200
-----------------------------------------------------
Fax | 631-254-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WILLIAM GRAY HUDKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-667-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------