Provider Demographics
NPI:1659382364
Name:HE, LAN (MD)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:HE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5833
Mailing Address - Country:US
Mailing Address - Phone:718-575-5108
Mailing Address - Fax:
Practice Address - Street 1:81 ELIZABETH ST.
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4159
Practice Address - Country:US
Practice Address - Phone:212-267-2388
Practice Address - Fax:212-267-1344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884371Medicaid
NY01884371Medicaid
NY41N051Medicare ID - Type Unspecified
NY41N05WT501Medicare PIN