Provider Demographics
NPI:1770571135
Name:LANTIN, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:LANTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-0788
Mailing Address - Country:US
Mailing Address - Phone:914-391-1274
Mailing Address - Fax:929-441-6911
Practice Address - Street 1:1086 N BROADWAY STE 50
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1115
Practice Address - Country:US
Practice Address - Phone:914-375-6400
Practice Address - Fax:929-441-6911
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY190136207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01545091Medicaid
NY01545091Medicaid
NY01545091Medicaid
NY133901519OtherTIN