1700865953 NPI number — DR. SAMUEL LANDSMAN PH.D.

Table of content: DR. SAMUEL LANDSMAN PH.D. (NPI 1700865953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700865953 NPI number — DR. SAMUEL LANDSMAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDSMAN
Provider First Name:
SAMUEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700865953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 SUNNYSIDE BLVD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-677-1932
Provider Business Mailing Address Fax Number:
516-677-1932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 SUNNYSIDE BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-677-1932
Provider Business Practice Location Address Fax Number:
516-677-1932
Provider Enumeration Date:
01/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  011078 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: 011078 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 011078 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118372 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6892895 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 011078 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 80374 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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