Provider Demographics
NPI:1588696710
Name:BRIAN R LANDZBERG MD LLC
Entity type:Organization
Organization Name:BRIAN R LANDZBERG MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-823-7651
Mailing Address - Street 1:50 EAST 69TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-737-5000
Mailing Address - Fax:212-157-0003
Practice Address - Street 1:50 EAST 69TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-737-5000
Practice Address - Fax:212-157-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02624239Medicaid
H41310Medicare UPIN
NY02624239Medicaid