Healthcare Provider Details

I. General information

NPI: 1760458715
Provider Name (Legal Business Name): DULCE M ALMANZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 5TH AVE
BAY SHORE NY
11706-4131
US

IV. Provider business mailing address

152 GENEVA ST
BAY SHORE NY
11706-4636
US

V. Phone/Fax

Practice location:
  • Phone: 631-647-3265
  • Fax: 631-647-3266
Mailing address:
  • Phone: 631-647-3265
  • Fax: 631-647-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223428
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: