Healthcare Provider Details

I. General information

NPI: 1952825671
Provider Name (Legal Business Name): CLIFFORD D GLUCK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 SHARP ST STE A10
HINGHAM MA
02043-4362
US

IV. Provider business mailing address

66 W GILBERT ST STE 200
TINTON FALLS NJ
07701-4948
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-6737
  • Fax: 781-337-6742
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLIFFORD D GLUCK
Title or Position: OWNER
Credential: MD
Phone: 781-337-6737