Individual
MR. KEITH SCOTT LANDHERR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
2400 JOHNSON AVE, #1-C, BRONX, NY 10463-6464
(718) 601-3629
(718) 601-3629
Mailing address
2400 JOHNSON AVE, #1-C, BRONX, NY 10463-6464
(718) 601-3629
(718) 601-3629
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
05789
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05789
NYS LICENSE# 5789
NY
Enumeration date
11/11/2008
Last updated
11/11/2008
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