Healthcare Provider Details

I. General information

NPI: 1821811191
Provider Name (Legal Business Name): SAMUEL LANDSMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNNYSIDE BLVD STE F
PLAINVIEW NY
11803-1517
US

IV. Provider business mailing address

66 WYOMING CT
SYOSSET NY
11791-3129
US

V. Phone/Fax

Practice location:
  • Phone: 516-677-1932
  • Fax: 516-677-1932
Mailing address:
  • Phone: 516-677-1932
  • Fax: 516-677-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAMUEL LANDSMAN
Title or Position: OWNER
Credential:
Phone: 516-677-1932