Provider Demographics
NPI:1114385440
Name:LANGER, JACOB C (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:C
Last Name:LANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WEMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6C2G3
Mailing Address - Country:CA
Mailing Address - Phone:416-813-7340
Mailing Address - Fax:416-813-7477
Practice Address - Street 1:730 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1503
Practice Address - Country:US
Practice Address - Phone:650-724-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1340032086S0120X
MOMD1018952086S0120X
CAC1339082086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH707190OtherCGS - MEDICARE
OH0388604Medicaid