Provider Demographics
NPI:1215082854
Name:ROBERT J LANDY
Entity type:Organization
Organization Name:ROBERT J LANDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-863-3338
Mailing Address - Street 1:1340 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:718-863-3338
Mailing Address - Fax:718-863-0936
Practice Address - Street 1:1340 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-863-3338
Practice Address - Fax:718-863-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005031332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477669Medicaid
NYP60391Medicare ID - Type Unspecified
NYU43159Medicare UPIN
NY01477669Medicaid
NY3980050001Medicare NSC