Provider Demographics
NPI:1407071319
Name:BELFOR, JENNIFER DENISE (OD OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DENISE
Last Name:BELFOR
Suffix:
Gender:F
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-868-3500
Mailing Address - Fax:516-368-3556
Practice Address - Street 1:939 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-868-3500
Practice Address - Fax:516-368-3556
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0046151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC44231Medicare UPIN
NY1081520001Medicare NSC