Provider Demographics
NPI:1700948759
Name:LANDERS, ALLEN M (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:M
Last Name:LANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:M
Other - Last Name:LANDERS MD, PC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13710 FRANKLIN AVE
Mailing Address - Street 2:#L2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3842
Mailing Address - Country:US
Mailing Address - Phone:718-359-5560
Mailing Address - Fax:718-359-5457
Practice Address - Street 1:13710 FRANKLIN AVE
Practice Address - Street 2:#L2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3842
Practice Address - Country:US
Practice Address - Phone:718-359-5560
Practice Address - Fax:718-359-5457
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDS495OtherOXFORD PROVIDER #
NYDS495OtherOXFORD PROVIDER #
NYGHI- 18444Medicare ID - Type UnspecifiedQUEENS OFFICE
NYB20311Medicare UPIN