Healthcare Provider Details

I. General information

NPI: 1346385069
Provider Name (Legal Business Name): ALTAGRACE BELMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3096 51ST ST
WOODSIDE NY
11377-1457
US

IV. Provider business mailing address

3725 HENRY HUDSON PKWY APT 6C
BRONX NY
10463-1527
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-1469
  • Fax: 718-545-1726
Mailing address:
  • Phone: 718-581-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: