Provider Demographics
NPI:1033887971
Name:LANCE, JOHN DAVID (LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:LANCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1474
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-0438
Mailing Address - Country:US
Mailing Address - Phone:631-407-0551
Mailing Address - Fax:
Practice Address - Street 1:43 NORTHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4695
Practice Address - Country:US
Practice Address - Phone:314-070-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist