Provider Demographics
NPI:1285520932
Name:LANE, RANDY LEE (LIC AC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:LANE
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 ROUTE 212
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3036
Mailing Address - Country:US
Mailing Address - Phone:310-741-0098
Mailing Address - Fax:
Practice Address - Street 1:83 MILL HILL RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1323
Practice Address - Country:US
Practice Address - Phone:917-594-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007669-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist