Provider Demographics
NPI:1760458715
Name:ALMANZAR, DULCE M (MD)
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:M
Last Name:ALMANZAR
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 1:152 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4636
Mailing Address - Country:US
Mailing Address - Phone:631-647-3265
Mailing Address - Fax:631-647-3266
Practice Address - Street 1:1377 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4131
Practice Address - Country:US
Practice Address - Phone:631-647-3265
Practice Address - Fax:631-647-3266
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
051206000006OtherFIDELIS
223428POtherHIP HEALTHCARE OF NY
P2866471OtherOXFORD HEALTH PLAN
NY5508D1OtherEMPIRE BLUE CROSS BLUE SH
NY02440893Medicaid
NY5508D1OtherEMPIRE BLUE CROSS BLUE SH
H99524Medicare UPIN