Provider Demographics
NPI:1558416149
Name:ROBERT J LANDY, DPM
Entity Type:Organization
Organization Name:ROBERT J LANDY, DPM
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:631-669-5440
Mailing Address - Street 1:799 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3812
Mailing Address - Country:US
Mailing Address - Phone:631-669-5440
Mailing Address - Fax:631-669-4403
Practice Address - Street 1:799 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3812
Practice Address - Country:US
Practice Address - Phone:631-669-5440
Practice Address - Fax:631-669-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-03-20
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
NYU43159Medicare UPIN
NYP60393Medicare ID - Type Unspecified
NY01477669Medicaid