Healthcare Provider Details

I. General information

NPI: 1114740099
Provider Name (Legal Business Name): MICHAEL JAY BELDOCK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PARK ST
OGDENSBURG NY
13669-3911
US

IV. Provider business mailing address

324 COUNTY ROUTE 51 BLDG 1
MALONE NY
12953-4502
US

V. Phone/Fax

Practice location:
  • Phone: 518-651-2302
  • Fax: 315-713-9330
Mailing address:
  • Phone: 518-651-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number626092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: