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General NPI Number Information
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NPI Number | 1952166118
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Entity Type | Individual
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Provider Name | CHRISTOPHER BRADLEY LANGE CPO
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Gender | Male
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 310 TAUGHANNOCK BLVD STE 1A
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City | ITHACA
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State | NY
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Zip | 14850-3251
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Country | US
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Telephone | 607-277-6620
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Fax | 607-277-2533
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Provider Business Mailing Address
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Address Line | 141 CEDAR LN
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City | GROTON
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State | NY
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Zip | 13073-1311
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Country | US
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Telephone | 607-330-2106
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Fax | 607-333-7925
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | OH000163
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | PO000109
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License Number State | PA
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