Provider Demographics
NPI:1205060159
Name:LANDERER, DAVID ALAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:LANDERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HEYWARD ST.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249
Mailing Address - Country:US
Mailing Address - Phone:718-260-4600
Mailing Address - Fax:718-852-0867
Practice Address - Street 1:14 HEYWARD ST.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249
Practice Address - Country:US
Practice Address - Phone:718-260-4600
Practice Address - Fax:718-852-0867
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine