Provider Demographics
NPI:1497019921
Name:LENGEN, EMILY
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:LENGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:PAVONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 ALDERBROOK TRAIL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-313-5711
Mailing Address - Fax:
Practice Address - Street 1:6 ALDERBROOK TRAIL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-313-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032561328Medicaid