Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X012879-1 | NY |
NPI | 1740707157 |
---|---|
Provider Name | Dr. Jason Langhough |
First Address | Woodbury, NY 11797-2905 |
Second Address | Woodbury, NY 11797-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |