Provider Demographics
NPI:1942218151
Name:LANDZBERG, KIM STARER (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:STARER
Last Name:LANDZBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NETHERLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4801
Mailing Address - Country:US
Mailing Address - Phone:718-548-5500
Mailing Address - Fax:718-549-0190
Practice Address - Street 1:2600 NETHERLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4801
Practice Address - Country:US
Practice Address - Phone:718-548-5500
Practice Address - Fax:718-549-0190
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02088113Medicaid
NY180003263OtherRAILROAD MEDICARE
NYKS0WZZQX10Medicare PIN
NY180003263OtherRAILROAD MEDICARE
NY46Z98ZZQX1Medicare PIN
NY46Z981Medicare ID - Type Unspecified
NYKL046Z9810Medicare PIN