Provider Demographics
NPI:1225211782
Name:BELESIS, MARIA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BELESIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7118 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2720
Mailing Address - Country:US
Mailing Address - Phone:718-793-3405
Mailing Address - Fax:718-263-3186
Practice Address - Street 1:7118 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2720
Practice Address - Country:US
Practice Address - Phone:718-793-3405
Practice Address - Fax:718-263-3186
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562463Medicaid