Provider Demographics
NPI:1003856964
Name:LAN, ANDREW E (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:LAN
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 1:1010 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1044
Mailing Address - Country:US
Mailing Address - Phone:914-964-4000
Mailing Address - Fax:914-964-4044
Practice Address - Street 1:1010 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1044
Practice Address - Country:US
Practice Address - Phone:914-964-4000
Practice Address - Fax:914-964-4044
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07724400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0255K1OtherWELLCHOICE
NJ0064408Medicaid
NJP3324373OtherOXFORD
0502624002OtherCIGNA
041164OtherAETNA
526293Medicare ID - Type Unspecified
CG1811Medicare PIN
0255K1OtherWELLCHOICE