Provider Demographics
NPI:1487897062
Name:LANG, JENNIFER KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHERINE
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1020 YOUNGS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2698
Mailing Address - Country:US
Mailing Address - Phone:716-961-9900
Mailing Address - Fax:716-961-9911
Practice Address - Street 1:1020 YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2698
Practice Address - Country:US
Practice Address - Phone:716-961-9900
Practice Address - Fax:716-961-9911
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY273713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04155464Medicaid
NY04155464Medicaid