Provider Demographics
NPI:1780679001
Name:LANG, PAUL BRUCE (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRUCE
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 HOLLOW LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-365-6666
Mailing Address - Fax:516-365-2183
Practice Address - Street 1:1 HOLLOW LN
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1215
Practice Address - Country:US
Practice Address - Phone:516-365-6666
Practice Address - Fax:516-365-2183
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY123911207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123911OtherHIP
NY4217564OtherAETNA US HEALTHCARE
NYAS592OtherOXFORD
NY32616OtherBLUE CROSS BLUE SHIELD
NY4C5815OtherHEALTHNET
NYAA00770OtherMDNY
NY14837OtherVYTRA
NY645380OtherUNITED HEALTHCARE
NY0001454OtherGHI
NY0330610-032OtherCIGNA
NY01454GOtherGHI MEDICARE
NY802789OtherFIRST HEALTH
NY0330610-032OtherCIGNA
NY326161Medicare ID - Type UnspecifiedBCBS MEDICARE