Provider Demographics
NPI:1932271368
Name:LAURENCE D LANDAU DPM PC
Entity Type:Organization
Organization Name:LAURENCE D LANDAU DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-233-1919
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-0416
Mailing Address - Country:US
Mailing Address - Phone:516-233-1919
Mailing Address - Fax:516-731-7302
Practice Address - Street 1:4230 HEMPSTEAD TPKE STE 200
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-233-1919
Practice Address - Fax:516-731-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005051174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01407767Medicaid
4699430001Medicare NSC
NYA100024196Medicare PIN
NY01407767Medicaid