Provider Demographics
NPI:1689780900
Name:SHOSHANA LANDOW, M.D. P.C.
Entity Type:Organization
Organization Name:SHOSHANA LANDOW, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-858-6758
Mailing Address - Street 1:185 MONTAGUE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3608
Mailing Address - Country:US
Mailing Address - Phone:718-858-6758
Mailing Address - Fax:718-625-4247
Practice Address - Street 1:185 MONTAGUE ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3608
Practice Address - Country:US
Practice Address - Phone:718-858-6758
Practice Address - Fax:718-625-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2215353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU601Medicare ID - Type Unspecified