Provider Demographics
NPI:1477508158
Name:GLODOWSKI, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:GLODOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4462
Mailing Address - Country:US
Mailing Address - Phone:718-424-4646
Mailing Address - Fax:718-424-4348
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:STE 304
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1606
Practice Address - Country:US
Practice Address - Phone:718-424-4646
Practice Address - Fax:718-424-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00937059Medicaid
NYA63446Medicare UPIN
NY60D961Medicare ID - Type Unspecified
NY00937059Medicaid