Provider Demographics
NPI:1013950310
Name:LANDESMAN, KEN PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:PHILIP
Last Name:LANDESMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S BEDFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3440
Mailing Address - Country:US
Mailing Address - Phone:914-241-2020
Mailing Address - Fax:914-241-0034
Practice Address - Street 1:103 S BEDFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3440
Practice Address - Country:US
Practice Address - Phone:914-241-2020
Practice Address - Fax:914-241-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00414P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC33102Medicare PIN
T49086Medicare UPIN
NY1202240001Medicare NSC