Healthcare Provider Details

I. General information

NPI: 1366600298
Provider Name (Legal Business Name): GLORIMAR ATILES MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD SUITE 304
ALBANY NY
12208-1742
US

IV. Provider business mailing address

PO BOX 194
ALBANY NY
12201-0194
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-5206
  • Fax: 518-525-5209
Mailing address:
  • Phone: 518-525-5206
  • Fax: 518-525-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLORIMAR ATILES
Title or Position: OWNER MD
Credential: MD
Phone: 518-525-5206