Provider Demographics
NPI:1306030697
Name:LANDA, TAL (MPT)
Entity Type:Individual
Prefix:MS
First Name:TAL
Middle Name:
Last Name:LANDA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405E 75TH ST.
Mailing Address - Street 2:HSS SPINE THERAPY CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-714-6850
Mailing Address - Fax:
Practice Address - Street 1:1400 YORK AVE
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3443
Practice Address - Country:US
Practice Address - Phone:212-988-9057
Practice Address - Fax:212-988-9196
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029411-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1887QA561Medicare PIN