Provider Demographics
NPI:1538447438
Name:CANO-LANDIVAR, JEANNETTE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:ELIZABETH
Last Name:CANO-LANDIVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNETTE
Other - Middle Name:ELIZABETH
Other - Last Name:CANO-LANDIVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10119 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2008
Mailing Address - Country:US
Mailing Address - Phone:718-709-4721
Mailing Address - Fax:
Practice Address - Street 1:10119 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2008
Practice Address - Country:US
Practice Address - Phone:718-709-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine