Provider Demographics
NPI:1609857010
Name:LANCMAN, MARCELO E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:E
Last Name:LANCMAN
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 1:333 WESTCHESTER AVE STE E104
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2930
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:333 WESTCHESTER AVE STE E104
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2930
Practice Address - Country:US
Practice Address - Phone:914-428-3651
Practice Address - Fax:914-428-2948
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2092382084N0400X, 2084N0600X
NJ673362084N0600X, 2084N0400X
CT0404492084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01933691Medicaid
NJ7832702Medicaid
NY92Z291Medicare ID - Type Unspecified
G78536Medicare UPIN
CTD400044749Medicare PIN
NJ021881Medicare ID - Type Unspecified