Basic Information
| Provider Information | |||||||||
| NPI: | 1164573036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDICHO | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | RONGO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PENN PLAZA, 7TH FL. STE. 725 | ||||||||
| Address2: | EVERCARE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122166793 | ||||||||
| FaxNumber: | 2122166606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PENN PLAZA, 7TH FL. STE. 725 | ||||||||
| Address2: | EVERCARE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122166793 | ||||||||
| FaxNumber: | 2122166606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 334063 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F1103327 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.