Provider Demographics
NPI:1952617649
Name:GLENEIDA MEDICAL CARE,PC
Entity Type:Organization
Organization Name:GLENEIDA MEDICAL CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-228-7000
Mailing Address - Street 1:91 GLENEIDA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1222
Mailing Address - Country:US
Mailing Address - Phone:845-228-7000
Mailing Address - Fax:845-228-5485
Practice Address - Street 1:1579 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7838
Practice Address - Country:US
Practice Address - Phone:845-635-8484
Practice Address - Fax:845-228-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty