Provider Demographics
NPI:1821278615
Name:LANDAU, KEITH
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:LANDAU
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:LANDAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:3900 SHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1130
Mailing Address - Country:US
Mailing Address - Phone:718-891-0680
Mailing Address - Fax:718-891-0681
Practice Address - Street 1:3900 SHORE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1130
Practice Address - Country:US
Practice Address - Phone:718-891-0680
Practice Address - Fax:718-891-0681
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011487-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02782869Medicaid