Provider Demographics
NPI:1952166118
Name:LANGE, CHRISTOPHER BRADLEY (CPO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BRADLEY
Last Name:LANGE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1311
Mailing Address - Country:US
Mailing Address - Phone:607-330-2106
Mailing Address - Fax:607-333-7925
Practice Address - Street 1:310 TAUGHANNOCK BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3251
Practice Address - Country:US
Practice Address - Phone:607-277-6620
Practice Address - Fax:607-277-2533
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000163222Z00000X
PAPO000109224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist