Provider Demographics
NPI:1710497599
Name:LANDVIGER, KATSIARYNA
Entity Type:Individual
Prefix:
First Name:KATSIARYNA
Middle Name:
Last Name:LANDVIGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 HOMECREST AVE APT 2J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4533
Mailing Address - Country:US
Mailing Address - Phone:347-968-4809
Mailing Address - Fax:
Practice Address - Street 1:2665 HOMECREST AVE APT 2J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4533
Practice Address - Country:US
Practice Address - Phone:347-968-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant