MEDICARE: GLENWOOD MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	192310	NY

General Provider Information

NPI Number	:	1518234145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENWOOD MEDICAL PC

Provider Business Mailing Address
First Line	:	11572 FRANCIS LEWIS BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1028
Country	:	US
Telephone Number	:	718-276-8666
Fax Number	:	718-276-4158

Provider Business Practice Location Address
First Line	:	11572 FRANCIS LEWIS BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1028
Country	:	US
Telephone Number	:	718-276-8666
Fax Number	:	718-276-4158

Authorized Official
Title or Position	:	MD
Name	:	OSAFRADU OPAM
Credential	:
Telephone Number	:	718-276-8666

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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Directions to “GLENWOOD MEDICAL PC ” Practice Location

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