Provider Demographics
NPI:1700118239
Name:LUCILLE BELNICK MD PA CORP
Entity Type:Organization
Organization Name:LUCILLE BELNICK MD PA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-679-3400
Mailing Address - Street 1:5474 LAKE HOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-679-3400
Mailing Address - Fax:407-679-3412
Practice Address - Street 1:5474 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1034
Practice Address - Country:US
Practice Address - Phone:407-679-3400
Practice Address - Fax:407-679-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275517690OtherNPI