Provider Demographics
NPI:1750644316
Name:LANGE, NANCY PATRICIA (MS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:PATRICIA
Last Name:LANGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 107TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3007
Mailing Address - Country:US
Mailing Address - Phone:917-689-7459
Mailing Address - Fax:
Practice Address - Street 1:210 W 107TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3007
Practice Address - Country:US
Practice Address - Phone:917-689-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY461962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist