Provider Demographics
NPI:1013330778
Name:LANE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 HENRY HUDSON PKWY W
Mailing Address - Street 2:11G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3231
Mailing Address - Country:US
Mailing Address - Phone:914-424-1591
Mailing Address - Fax:
Practice Address - Street 1:4705 HENRY HUDSON PKWY W
Practice Address - Street 2:11G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3231
Practice Address - Country:US
Practice Address - Phone:914-424-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator