Provider Demographics
NPI:1639169287
Name:LANGE-KESSLER, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LANGE-KESSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000007054210OtherGHI HMO #
NY02064060Medicaid
NY283155OtherWELLCARE #
NY7399252OtherAETNA PPO #
NY2607722OtherAETNA HMO #
NYP2100246OtherOXFORD #
NY1899849OtherGHI PPO #
NY4129558OtherMVP #
NYM0M071OtherEMPIRE BCBS #
NY1000022364OtherAFFINITY HEALTH PLAN #
NYP2100246OtherOXFORD #
NYMEM021Medicare PIN