Provider Demographics
NPI:1760786388
Name:MO, LAN (MD)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:MO
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 1:575 LEXLINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:212-312-5920
Mailing Address - Fax:212-571-7465
Practice Address - Street 1:156 WILLIAM ST FL 7
Practice Address - Street 2:7TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5327
Practice Address - Country:US
Practice Address - Phone:212-312-5920
Practice Address - Fax:212-571-7465
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262717207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology