Provider Demographics
NPI:1376762484
Name:THOMAS K. LANDAU MDPC
Entity Type:Organization
Organization Name:THOMAS K. LANDAU MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-381-2995
Mailing Address - Street 1:444 E BOSTON POST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3708
Mailing Address - Country:US
Mailing Address - Phone:914-381-2995
Mailing Address - Fax:914-381-7346
Practice Address - Street 1:444 E BOSTON POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3708
Practice Address - Country:US
Practice Address - Phone:914-381-2995
Practice Address - Fax:914-381-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109097207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID#
NY631301Medicare ID - Type UnspecifiedMEDICARE ID #