Provider Demographics
NPI:1184683823
Name:BOTER, LANA (MD, PPLC)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:BOTER
Suffix:
Gender:F
Credentials:MD, PPLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 33RD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4804
Mailing Address - Country:US
Mailing Address - Phone:212-696-5880
Mailing Address - Fax:
Practice Address - Street 1:251 E 33RD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4804
Practice Address - Country:US
Practice Address - Phone:212-696-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02404442Medicaid
NY02404442Medicaid
NY701E71Medicare ID - Type Unspecified