Healthcare Provider Details

I. General information

NPI: 1366353039
Provider Name (Legal Business Name): PEPTIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 MERRICK RD
MASSAPEQUA NY
11758-6001
US

IV. Provider business mailing address

4333 MERRICK RD
MASSAPEQUA NY
11758-6001
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-1591
  • Fax:
Mailing address:
  • Phone: 516-541-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE LANDAU
Title or Position: OWNER
Credential:
Phone: 516-541-1591