1619071198 NPI number — MR. THOMAS LEE LANGKAU BSW, FCWP

Table of content: MR. THOMAS LEE LANGKAU BSW, FCWP (NPI 1619071198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619071198 NPI number — MR. THOMAS LEE LANGKAU BSW, FCWP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGKAU
Provider First Name:
THOMAS
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSW, FCWP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619071198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8485 ANSON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-9387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-629-1599
Provider Business Mailing Address Fax Number:
321-397-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 RAYMOND ST
Provider Second Line Business Practice Location Address:
C/O VETERANS ADMINISTRATION
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-629-1599
Provider Business Practice Location Address Fax Number:
321-397-6099
Provider Enumeration Date:
09/12/2006

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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