Provider Demographics
NPI:1720107584
Name:LNW MEDICAL OFFICE, PLLC
Entity Type:Organization
Organization Name:LNW MEDICAL OFFICE, PLLC
Other - Org Name:LNW MEDICAL OFFICE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-8386
Mailing Address - Street 1:33 WALT WHITMAN RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3631
Mailing Address - Country:US
Mailing Address - Phone:631-965-8166
Mailing Address - Fax:718-732-2062
Practice Address - Street 1:33 WALT WHITMAN RD STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3631
Practice Address - Country:US
Practice Address - Phone:631-965-8166
Practice Address - Fax:718-732-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188903170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663538Medicaid
FLF51863Medicare UPIN
NY46808Medicare ID - Type Unspecified