Healthcare Provider Details

I. General information

NPI: 1386646842
Provider Name (Legal Business Name): FRANCES L GLICKSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 03/22/2006
Reactivation Date: 09/19/2007

III. Provider practice location address

4302 ALTON RD SUITE 105
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

5 CHIPPEWA CT
SUFFERN NY
10901-4158
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-1887
  • Fax: 305-674-1890
Mailing address:
  • Phone: 305-793-7049
  • Fax: 305-674-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0051210
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number157528-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: