Provider Demographics
NPI:1215027412
Name:BELOK, LENNART C (MD)
Entity type:Individual
Prefix:
First Name:LENNART
Middle Name:C
Last Name:BELOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8112
Mailing Address - Country:US
Mailing Address - Phone:212-265-9716
Mailing Address - Fax:212-477-6533
Practice Address - Street 1:410 E 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-8112
Practice Address - Country:US
Practice Address - Phone:212-265-9716
Practice Address - Fax:212-477-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1207942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0040473OtherGHI
NY80141OtherHEALTH FIRST
NY08A701OtherEMPIRE BLUECR/BLUESHIELD
NY00499270Medicaid
NY120794OtherOXFORD
NY120794OtherHIP OF NY
NY90540OtherAETNA US HEALTH CARE
NY120794OtherMEDICAL LICENSE
NY120794OtherMEDICAL LICENSE
NY90540OtherAETNA US HEALTH CARE