Healthcare Provider Details

I. General information

NPI: 1689008997
Provider Name (Legal Business Name): PHYSICIAN LANDING ZONE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LONGFELLOW ST SUITE 200
VANDERGRIFT PA
15690-1476
US

IV. Provider business mailing address

120 5TH AVE MAIL DROP 2516
PITTSBURGH PA
15222-3000
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-5551
  • Fax: 724-568-3137
Mailing address:
  • Phone: 412-544-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD038760L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier11
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCMS SPECIALITY CODES
# 2
Identifier207RG0300X
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTAXONOMY

VIII. Authorized Official

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