MEDICARE: GLENDALE MEDICAL ASSOCIATES 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	207Q00000X	Family Medicine Physician	193881	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922006725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	7401 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-821-5500
Fax Number	:	718-456-0778

Provider Business Practice Location Address
First Line	:	7401 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-821-5500
Fax Number	:	718-456-0778

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RONALD LANGMAN
Credential	:	DO
Telephone Number	:	718-821-5500

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/22/2020

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