Provider Demographics
NPI:1730353848
Name:LANDZBERG, BRIAN R (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:LANDZBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 79TH ST # 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0999
Mailing Address - Country:US
Mailing Address - Phone:917-544-6060
Mailing Address - Fax:212-570-0035
Practice Address - Street 1:311 E 79 ST
Practice Address - Street 2:2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0999
Practice Address - Country:US
Practice Address - Phone:917-544-6060
Practice Address - Fax:212-570-0035
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH41310Medicare UPIN
NY3V080ET671Medicare PIN