Healthcare Provider Details

I. General information

NPI: 1285072405
Provider Name (Legal Business Name): PHYSICIAN LANDING ZONE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 WASHINGTON RD
MC MURRAY PA
15317-2964
US

IV. Provider business mailing address

3402 WASHINGTON RD
MC MURRAY PA
15317-2964
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-5188
  • Fax: 724-942-5878
Mailing address:
  • Phone: 724-942-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD040157L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0011922720004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1386613131
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. WILLIAM GOLDFARB
Title or Position: PRESIDENT
Credential: MD
Phone: 412-578-7080