Provider Demographics
NPI:1497701627
Name:LANE, JOHN F (MD,)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:LANE
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 1:65 MOUNTAIN BLVD EXT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2632
Mailing Address - Country:US
Mailing Address - Phone:732-356-6200
Mailing Address - Fax:732-356-9257
Practice Address - Street 1:65 MOUNTAIN BLVD EXT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2632
Practice Address - Country:US
Practice Address - Phone:732-356-6200
Practice Address - Fax:732-356-9257
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06518000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7166109Medicaid
NJ7166109Medicaid
NJG53094Medicare UPIN