Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 195170 | NY |
NPI | 1225070451 |
---|---|
Provider Name | Dr. Andrew Lane |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/04/2015 |