Provider Demographics
NPI:1598817629
Name:BELANDRIA, EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:BELANDRIA
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 1:407 PARK AVE S
Mailing Address - Street 2:APT. 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8414
Mailing Address - Country:US
Mailing Address - Phone:212-923-1774
Mailing Address - Fax:212-928-7732
Practice Address - Street 1:706 W 180TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5617
Practice Address - Country:US
Practice Address - Phone:212-923-1774
Practice Address - Fax:212-928-7732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8056Medicare UPIN
NY30D121Medicare ID - Type Unspecified