Individual
GREGG S LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1999 MARCUS AVE, SUITE 106B, NEW HYDE PARK, NY 11042-1033
(516) 233-3607
(718) 962-2239
Mailing address
1999 MARCUS AVE, SUITE 106B, NEW HYDE PARK, NY 11042-1033
(516) 233-3607
(718) 962-2239
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
221796
NY
2086S0129X
Vascular Surgery Physician
Primary
221796
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00770K
MEDICARE PTAN - NYHMCQ-AMBSURG
NY
05
—
02270024
—
NY
01
—
P00262367
RAILROAD MEDICARE - CRT
NY
Enumeration date
05/27/2006
Last updated
08/09/2013
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