Mario E. Landaverde, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86062371 Issued in NY

Practice address

135 W 96TH St Apt 8B
New York, NY 10025-9221

Phone

(917) 691-9776

NPI assigned

Jul 7, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boro Park Nutrition LLCGroup PAC ID 7012334402, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boro Park Nutrition, LLC

  • Nutritionist
  • Brooklyn, NY
  • NPI 1821511262
  Medicare reassignment Care Compare group NPD
• Boro Park Dietitian

  • Registered Dietitian
  • Brooklyn, NY
  • NPI 1174385223

  Dietitian, Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1972121903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 W 96TH ST APT 8B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100259221",
            "telephone_number": "917-691-9776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W 96TH ST APT 8B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100259221",
            "telephone_number": "917-691-9776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDAVERDE",
        "first_name": "MARIO",
        "middle_name": "E.",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "86062371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Wendy Landau, MD
• Laura Marie Landau, LCSW
• Phyllis Susan Landau, MD
• Ruth Landau Landau, M.D.
• Zoe Aliyah Landau, MD
• Margaly Lande
• Amber Landeau Keinan, LMSW
• Ivan Patrick Landego, MD
• Bradley S Lander, MD
• Jennifer Lander, DVM

• Registered Dietitian in New York, NY
• Providers in New York, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.