Healthcare Provider Details

I. General information

NPI: 1902151038
Provider Name (Legal Business Name): ELLIOT LANDAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

612 CORPORATE WAY STE 1M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6205
  • Fax:
Mailing address:
  • Phone: 844-362-3425
  • Fax: 718-362-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0093235
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number271941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: