=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942406897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAN HE PHYSICIAN PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2007
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 ELIZABETH STREET SUITE 501
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-237-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 ELIZABETH STREET SUITE 501
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-237-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LAN HE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-267-2388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------