Provider Demographics
NPI:1679676647
Name:LANDSMAN, MARK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:LANDSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4538
Mailing Address - Country:US
Mailing Address - Phone:212-785-1717
Mailing Address - Fax:
Practice Address - Street 1:42 BROADWAY
Practice Address - Street 2:SUITE 1530
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1617
Practice Address - Country:US
Practice Address - Phone:212-785-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004344213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51493Medicare UPIN
NYP46362Medicare PIN
NYP46363Medicare PIN
NYP46361Medicare PIN