Basic Information
Provider Information | |||||||||
NPI: | 1023321288 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PALLACK | ||||||||
FirstName: | ROBYN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LANDY | ||||||||
OtherFirstName: | ROBYN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 11781 LEE JACKSON MEMORIAL HWY | ||||||||
Address2: | SUITE 550 | ||||||||
City: | FAIRFAX | ||||||||
State: | VA | ||||||||
PostalCode: | 220333309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5717775157 | ||||||||
FaxNumber: | 7038902650 | ||||||||
Practice Location | |||||||||
Address1: | 221 JERICHO TPKE | ||||||||
Address2: |   | ||||||||
City: | SYOSSET | ||||||||
State: | NY | ||||||||
PostalCode: | 117914515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5164966400 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/16/2010 | ||||||||
LastUpdateDate: | 09/14/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 275050 | NY | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.