Healthcare Provider Details

I. General information

NPI: 1720040629
Provider Name (Legal Business Name): NEW YORK IMMUNOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 MAIN ST
FLUSHING NY
11367-1703
US

IV. Provider business mailing address

6920 MAIN ST
FLUSHING NY
11367-1703
US

V. Phone/Fax

Practice location:
  • Phone: 718-793-9020
  • Fax:
Mailing address:
  • Phone: 718-793-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number184552
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number184552
License Number StateNY

VIII. Authorized Official

Name: MICHAEL LANDOR
Title or Position: DIRECTOR OFFICER
Credential: MD
Phone: 718-793-9020