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General NPI Number Information
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NPI Number | 1922006725
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Entity Type | Organization
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Legal Business Name | GLENDALE MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7401 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7433
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Country | US
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Telephone | 718-821-5500
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Fax | 718-456-0778
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Provider Business Mailing Address
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Address Line | 7401 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7433
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Country | US
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Telephone | 718-821-5500
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Fax | 718-456-0778
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RONALD LANGMAN
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Credential | DO
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Telephone | 718-821-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 193881
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License Number State | NY
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