Healthcare Provider Details

I. General information

NPI: 1023321288
Provider Name (Legal Business Name): ROBYN PALLACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN LANDY M.D.

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6400
  • Fax:
Mailing address:
  • Phone: 571-777-5157
  • Fax: 703-890-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number275050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: