Provider Demographics
NPI:1013157247
Name:GLENWOOD MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:GLENWOOD MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BELZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-295-2812
Mailing Address - Street 1:88 REEVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLVILLE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:347-295-2812
Mailing Address - Fax:347-295-2813
Practice Address - Street 1:8806 GLENWOOD RD
Practice Address - Street 2:STE#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:347-295-2812
Practice Address - Fax:347-295-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1943262084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03305162Medicaid
NY03305162Medicaid