Provider Demographics
NPI:1346385069
Name:BELMAR, ALTAGRACE (MD)
Entity Type:Individual
Prefix:
First Name:ALTAGRACE
Middle Name:
Last Name:BELMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1527
Mailing Address - Country:US
Mailing Address - Phone:718-581-0805
Mailing Address - Fax:
Practice Address - Street 1:3096 51ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1457
Practice Address - Country:US
Practice Address - Phone:718-204-1469
Practice Address - Fax:718-545-1726
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02256339Medicaid