Active NPI
Keith Scott Landherr, OTR/L
- Community Health Worker
- Bronx, NY
National Provider Identifier
1689828139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 05789
- Practice address
- 2400 Johnson Ave
#1-C
Bronx, NY 10463-6464 - Phone
- (718) 601-3629
- Fax
- (718) 601-3629
- NPI assigned
- Nov 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 05789 | NY | Primary |
Addresses
Primary practice location
2400 Johnson Ave
#1-C
Bronx, NY 10463-6464
Mailing address
2400 Johnson Ave
#1-C
Bronx, NY 10463-6464
Phone (718) 601-3629
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05789 | Other | NY | NYS LICENSE# 5789 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05789 | NY | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226361600000",
"number": "1689828139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 JOHNSON AVE",
"address_2": "#1-C",
"city": "BRONX",
"state": "NY",
"postal_code": "104636464",
"telephone_number": "718-601-3629",
"fax_number": "718-601-3629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 JOHNSON AVE",
"address_2": "#1-C",
"city": "BRONX",
"state": "NY",
"postal_code": "104636464",
"telephone_number": "718-601-3629",
"fax_number": "718-601-3629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDHERR",
"first_name": "KEITH",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-11",
"last_updated": "2008-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "05789",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS LICENSE# 5789",
"identifier": "05789",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.