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General NPI Number Information
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NPI Number | 1518234145
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Entity Type | Organization
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Legal Business Name | GLENWOOD MEDICAL PC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 11572 FRANCIS LEWIS BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1028
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Country | US
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Telephone | 718-276-8666
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Fax | 718-276-4158
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Provider Business Mailing Address
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Address Line | 11572 FRANCIS LEWIS BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1028
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Country | US
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Telephone | 718-276-8666
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Fax | 718-276-4158
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Authorized Official
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Title or Position | MD
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Name | OSAFRADU OPAM
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Credential |
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Telephone | 718-276-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | 192310
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License Number State | NY
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