Healthcare Provider Details

I. General information

NPI: 1114914611
Provider Name (Legal Business Name): GLENN J BELKIN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GRASSLANDS RD STE 200
VALHALLA NY
10595-1503
US

IV. Provider business mailing address

22 SAW MILL RIVER RD 2ND FLOOR
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 914-304-5250
  • Fax: 914-345-1752
Mailing address:
  • Phone: 914-304-5250
  • Fax: 914-345-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number135721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: