MEDICARE: PAUL BRUCE LANG MD

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	207K00000X	Allergy & Immunology Physician	123911	NY
2	207KA0200X	Allergy Physician	123911	NY
3	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	123911	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	01454G	OTHER	NY	GHI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123911	OTHER	NY	HIP
2	4217564	OTHER	NY	AETNA US HEALTHCARE
3	AS592	OTHER	NY	OXFORD
4	32616	OTHER	NY	BLUE CROSS BLUE SHIELD
5	4C5815	OTHER	NY	HEALTHNET
6	AA00770	OTHER	NY	MDNY
7	14837	OTHER	NY	VYTRA
8	645380	OTHER	NY	UNITED HEALTHCARE
9	0001454	OTHER	NY	GHI
10	0330610-032	OTHER	NY	CIGNA
12	802789	OTHER	NY	FIRST HEALTH

General Provider Information

NPI Number	:	1780679001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BRUCE LANG MD

Provider Business Mailing Address
First Line	:	1 HOLLOW LN
Second Line	:	SUITE 110
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-365-6666
Fax Number	:	516-365-2183

Provider Business Practice Location Address
First Line	:	1 HOLLOW LN
Second Line	:	SUITE 110
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-365-6666
Fax Number	:	516-365-2183

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/04/2013

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