Provider Demographics
NPI:1871566547
Name:KRANZ, DALE LANE (PT)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:LANE
Last Name:KRANZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 MERRICK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4642
Mailing Address - Country:US
Mailing Address - Phone:516-623-9145
Mailing Address - Fax:516-867-8576
Practice Address - Street 1:1955 MERRICK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4642
Practice Address - Country:US
Practice Address - Phone:516-623-9145
Practice Address - Fax:516-867-8576
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004274-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0099599OtherGHI
NY013516OtherMEDICARE SUBMITTER NUMBER
NYDK0Q303420OtherBCBS
NY004274-1OtherHEALTHFIRST
NY6680086001OtherCIGNA
NY452017OtherAETNA
NY811296OtherMANAGED PHYSICAL NETWORK
NY004274-1OtherHEALTHFIRST
NY0099599OtherGHI