MEDICARE: MS. NANCY PATRICIA LANGE MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	461962	NY

General Provider Information

NPI Number	:	1750644316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY PATRICIA LANGE MS

Provider Business Mailing Address
First Line	:	210 W 107TH ST APT 1F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3007
Country	:	US
Telephone Number	:	917-689-7459
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 W 107TH ST APT 1F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3007
Country	:	US
Telephone Number	:	917-689-7450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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