Provider Demographics
NPI:1063672327
Name:EDWARD LANG
Entity Type:Organization
Organization Name:EDWARD LANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-897-3627
Mailing Address - Street 1:PO BOX 7764
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7764
Mailing Address - Country:US
Mailing Address - Phone:504-897-3627
Mailing Address - Fax:504-897-3339
Practice Address - Street 1:2626 JENA ST.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6325
Practice Address - Country:US
Practice Address - Phone:504-897-3627
Practice Address - Fax:504-897-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD092R213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388351Medicaid
LA1190060001Medicare NSC
T86556Medicare UPIN
1699798769Medicare PIN