NPIMap

Individual provider Active NPI

Teresa V Dombek-Lang, M.D.

  • Family Medicine Physician
  • Gouverneur, NY
National Provider Identifier
1699771295
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
243016 Issued in NY
Practice address
77 W. Barney St.
Gouverneur, NY 13642
Phone
(315) 287-4440
Fax
(315) 287-1858
NPI assigned
Jun 28, 2005
Last updated
May 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X EL221009 ME
Family Medicine Physician 207Q00000X MD25662 ME
Family Medicine Physician 207Q00000X 243016 NY Primary

Addresses

Primary practice location

77 W. Barney St.
Gouverneur, NY 13642

Mailing address

4 Commerce LN
Canton, NY 13617-3739
Phone (315) 386-8191

Other identifiers 2

IdentifierTypeStateIssuer
02392854MedicaidNY
01995615MedicaidNY

Other names 1

  • Teresa V Dombeklang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311003521 NH Practitioner - Family Practice 5496729790 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

243 Elm St
Claremont, NH 03743-4921

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD25662MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Regional Hospital Inc. CurrentSince Feb 7, 2026 Accepting new patients
Valley Regional Hospital Inc. Family Medicine Current Accepting new patients
Valley Regional Hospital, Inc Family Medicine CurrentSince Jan 24, 2024 Accepting new patients
Bruce J Lewis M.D. Current Accepting new patients
Valley Regional Hospital ,Inc. CurrentSince Jan 24, 2024 Accepting new patients
Edward John Noble Hospital of Gouverneur Ny Swing Bed Unit Past Accepting new patients
Edward John Noble Hospital of Gouverneur Ny Past Accepting new patients

Locations

243 Elm St
Claremont, NH 03743
Phone (603) 542-7771

Interoperability endpoints

  • Direct secure messaging: lante@hiemail.healtheconnections.org
  • Direct secure messaging: teresalang@direct-riverhospital.org
  • Direct secure messaging: vrhtdombe@yourcarecommunity.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1699771295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 COMMERCE LN",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136173739",
            "telephone_number": "315-386-8191",
            "fax_number": "315-386-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W. BARNEY ST.",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "13642",
            "telephone_number": "315-287-4440",
            "fax_number": "315-287-1858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMBEK-LANG",
        "first_name": "TERESA",
        "middle_name": "V",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "EL221009",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD25662",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "243016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02392854",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01995615",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "DOMBEKLANG",
            "middle_name": "V",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gouverneur, NY

Sources for this page

Verify at the official NPI Registry.