Provider Demographics
NPI:1366600298
Name:GLORIMAR ATILES MD PLLC
Entity type:Organization
Organization Name:GLORIMAR ATILES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-525-5206
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-0194
Mailing Address - Country:US
Mailing Address - Phone:518-525-5206
Mailing Address - Fax:518-525-5209
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-525-5206
Practice Address - Fax:518-525-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02748112Medicaid