Basic Information
| Provider Information | |||||||||
| NPI: | 1649337122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAN | ||||||||
| FirstName: | FENGSHUO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D.,PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | STONY BROOK UNIVERSITY CANCER CTR | ||||||||
| Address2: | 3 EDMUND D. PELLEGRINO ROAD | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316381000 | ||||||||
| FaxNumber: | 6314440915 | ||||||||
| Practice Location | |||||||||
| Address1: | STONY BROOK UNIVERSITY CANCER CTR | ||||||||
| Address2: | 3 EDMUND D. PELLEGRINO ROAD | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316381000 | ||||||||
| FaxNumber: | 6314440915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 233819 | NY | N | Other Service Providers | Specialist | 207RH0003X | 233819 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 233819 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.