1700108016 NPI number — MS. HANNAH H LANGBERG N.P

Table of content: MS. HANNAH H LANGBERG N.P (NPI 1700108016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700108016 NPI number — MS. HANNAH H LANGBERG N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGBERG
Provider First Name:
HANNAH
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OH
Provider Other First Name:
HYUN
Provider Other Middle Name:
JOO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700108016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 BREN RD E
Provider Second Line Business Mailing Address:
MAIL ROUTE MN 008-B213
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55343-9664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-820-8079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
458 WESTVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-820-8079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  26NJ00276600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0727962 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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