Provider Demographics
NPI:1013379015
Name:LANSKY MEDICAL LLC
Entity Type:Organization
Organization Name:LANSKY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:LANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-985-3916
Mailing Address - Street 1:3900 S GOLDENROD RD STE 142
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5629
Mailing Address - Country:US
Mailing Address - Phone:407-985-3916
Mailing Address - Fax:407-985-3917
Practice Address - Street 1:3900 S GOLDENROD RD STE 142
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5629
Practice Address - Country:US
Practice Address - Phone:407-985-3916
Practice Address - Fax:407-985-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013637800Medicaid