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NPI Code Detail

MEDICARE: DR. LANDON M COLEMAN DNP, PMHNP-BC

MEDICARE: DR. LANDON M COLEMAN DNP, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP135672TX
22084P0800XPsychiatry Physician2372804NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12017000810OTHERANCC BOARD CERTIFICATION
2G153038OTHERIAAPRN STATE LICENSE
32372804OTHERNYNEW YORK APRN
4761730OTHERTXRN STATE LICENSE
5AP135672OTHERTXAPRN STATE LICENSE

General Provider Information

NPI Number : 1689113805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANDON M COLEMAN DNP, PMHNP-BC
Provider Business Mailing Address
First Line : 1199 PARK AVE APT 1C
Second Line :
City : NEW YORK
State : NY
Zip : 10128-1712
Country : US
Telephone Number : 201-986-6626
Fax Number :
Provider Business Practice Location Address
First Line : 1199 PARK AVE APT 1C
Second Line :
City : NEW YORK
State : NY
Zip : 10128-1712
Country : US
Telephone Number : 212-828-7473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2017
Last Update Date : 01/26/2024

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