Healthcare Provider Details

I. General information

NPI: 1649659806
Provider Name (Legal Business Name): SAMUEL MATTHEW LANDA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

4555 HENRY HUDSON PKWY APT 603
BRONX NY
10471-3844
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4444
  • Fax:
Mailing address:
  • Phone: 551-265-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number313711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: