Provider Demographics
NPI:1053370577
Name:LANKS, KARL W (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:W
Last Name:LANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1702
Mailing Address - Country:US
Mailing Address - Phone:917-361-6986
Mailing Address - Fax:718-783-4114
Practice Address - Street 1:868 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1702
Practice Address - Country:US
Practice Address - Phone:917-361-6986
Practice Address - Fax:718-783-4114
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1035221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B13371Medicare UPIN
NYKL034D0810Medicare ID - Type Unspecified