Provider Demographics
NPI:1972779205
Name:ALLIANCE MEDICAL &WELLNESS PLLC
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL &WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-980-4211
Mailing Address - Street 1:211 E 53RD ST
Mailing Address - Street 2:SUITE P-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4803
Mailing Address - Country:US
Mailing Address - Phone:212-980-4211
Mailing Address - Fax:212-980-1885
Practice Address - Street 1:211 E 53RD ST
Practice Address - Street 2:SUITE P-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4803
Practice Address - Country:US
Practice Address - Phone:212-980-4211
Practice Address - Fax:212-980-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859444208VP0014X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty