=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720086051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID M LANS DO FACP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 01/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 838 PELHAMDALE AVE
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-637-8809
-----------------------------------------------------
Fax | 914-235-7708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 838 PELHAMDALE AVE
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-637-8809
-----------------------------------------------------
Fax | 914-235-7708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 149715
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------