Provider Demographics
NPI:1457341562
Name:LANGE, JASON F (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:F
Last Name:LANGE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:532 MOE ROAD
Mailing Address - Street 2:FOUR SEASONS PEDIATRICS
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-383-2425
Mailing Address - Fax:518-383-3255
Practice Address - Street 1:532 MOE ROAD
Practice Address - Street 2:FOUR SEASONS PEDIATRICS
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-383-2425
Practice Address - Fax:518-383-3255
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232182208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics