Provider Demographics
NPI:1043455983
Name:GLANTZ, LEWIS
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2901
Mailing Address - Country:US
Mailing Address - Phone:845-354-8980
Mailing Address - Fax:
Practice Address - Street 1:1581 ROUTE 202
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2901
Practice Address - Country:US
Practice Address - Phone:845-354-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01528165Medicaid