Provider Demographics
NPI:1275504748
Name:LANG, LINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:J
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:3100 HWY 138
Mailing Address - Street 2:SUITE E
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9020
Mailing Address - Country:US
Mailing Address - Phone:732-280-9600
Mailing Address - Fax:732-280-9601
Practice Address - Street 1:3100 HWY 138
Practice Address - Street 2:SUITE E
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9020
Practice Address - Country:US
Practice Address - Phone:732-280-9600
Practice Address - Fax:732-280-9601
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA706682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8652309Medicaid
NJE51807Medicare UPIN
NJ038711C7FMedicare PIN