Lange, David Otto

Lange, David Otto is an sole proprietor health care provider with primary practice located at 2205 Nott St , Niskayuna NY 12309-4346. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Lange, David Otto can be contacted via phone (518) 374-3324.

Contact Information

Primary practice address
2205 Nott St Niskayuna NY 12309-4346
Fax: (518) 374-3325
Website:

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 040252 New York

Profile Details

NPI number 1114212255
LBN Legal business name Lange, David Otto
Credentials BS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2011
Last updated Jun 16th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114212255 NPPES
New York MEDICAID 00536094

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