Provider Demographics
NPI:1972666352
Name:GLENDALE MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GLENDALE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-821-5500
Mailing Address - Street 1:7401 MYRTILE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7433
Mailing Address - Country:US
Mailing Address - Phone:718-821-5500
Mailing Address - Fax:718-456-0778
Practice Address - Street 1:7401 MYRTILE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7433
Practice Address - Country:US
Practice Address - Phone:718-821-5500
Practice Address - Fax:718-456-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579304Medicaid
NY01579304Medicaid
NY00614Medicare PIN