Provider Demographics
NPI:1871857797
Name:LANDESMAN, RIVKA
Entity Type:Individual
Prefix:MRS
First Name:RIVKA
Middle Name:
Last Name:LANDESMAN
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 1:4815 15TH AVE
Mailing Address - Street 2:APT 5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3258
Mailing Address - Country:US
Mailing Address - Phone:718-435-3962
Mailing Address - Fax:
Practice Address - Street 1:4815 15TH AVE
Practice Address - Street 2:APT 5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3258
Practice Address - Country:US
Practice Address - Phone:718-435-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1184422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist