Provider Demographics
NPI:1841434529
Name:JEFFREY N LANDSBERG PT PLLC
Entity type:Organization
Organization Name:JEFFREY N LANDSBERG PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR PHYSICAL MEDICIN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:LANDSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-771-9666
Mailing Address - Street 1:PO BOX 11943
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1915 - 25 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2949
Practice Address - Country:US
Practice Address - Phone:914-761-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009470-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6415990001Medicare NSC
NYJ100000209Medicare PIN