1861438681 NPI number — LOUIS R BELZIE MD, PHD

Table of content: LOUIS R BELZIE MD, PHD (NPI 1861438681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861438681 NPI number — LOUIS R BELZIE MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELZIE
Provider First Name:
LOUIS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861438681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8806 GLENWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11236-3414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-295-2812
Provider Business Mailing Address Fax Number:
347-295-2813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8806 GLENWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-295-2812
Provider Business Practice Location Address Fax Number:
347-295-2813
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  194326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2540193 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6012079 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 370010480 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01681516 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194326-A41 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 900280701 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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