Provider Demographics
NPI:1184171514
Name:JONATHAN V. LANDON MD P.C.
Entity type:Organization
Organization Name:JONATHAN V. LANDON MD P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:LANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-482-1840
Mailing Address - Street 1:786 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4926
Mailing Address - Country:US
Mailing Address - Phone:631-669-3700
Mailing Address - Fax:
Practice Address - Street 1:98 PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1709
Practice Address - Country:US
Practice Address - Phone:631-482-1840
Practice Address - Fax:631-482-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255681-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty