Provider Demographics
NPI:1528038841
Name:LANGE, DALE J (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:J
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 1:15 ECHO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8752
Mailing Address - Country:US
Mailing Address - Phone:917-515-3110
Mailing Address - Fax:
Practice Address - Street 1:800A 5TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7215
Practice Address - Country:US
Practice Address - Phone:332-334-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1500482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008063221Medicaid
NY00780456Medicaid
NY013JT1OtherEMPIRE BLUE CROSS BLUE SHIELD
NYA400092639Medicare PIN
NY00780456Medicaid