Provider Demographics
NPI:1295778025
Name:ATILES, GLORIMAR (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIMAR
Middle Name:
Last Name:ATILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLORIMAR
Other - Middle Name:
Other - Last Name:ATILES-MALATINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-525-5206
Mailing Address - Fax:518-525-5209
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-525-5206
Practice Address - Fax:518-525-5209
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231845-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02748112Medicaid
NY02748112Medicaid