Provider Demographics
NPI:1508139007
Name:LANDOW, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:LANDOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 JERICHO TPKE
Mailing Address - Street 2:SUITE#212
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1344
Mailing Address - Country:US
Mailing Address - Phone:516-277-2121
Mailing Address - Fax:516-277-2122
Practice Address - Street 1:420 JERICHO TPKE
Practice Address - Street 2:SUITE#212
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1344
Practice Address - Country:US
Practice Address - Phone:516-277-2121
Practice Address - Fax:516-277-2122
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine