Provider Demographics
NPI:1477591196
Name:LANGE, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LANGE
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 1:703 MAIN ST
Mailing Address - Street 2:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-2052
Mailing Address - Fax:
Practice Address - Street 1:160 MARKET ST
Practice Address - Street 2:COMPREHENSIVE CARE CENTER
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1702
Practice Address - Country:US
Practice Address - Phone:973-754-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03220400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8780005Medicaid
067642B8AMedicare ID - Type Unspecified
NJ8780005Medicaid