Healthcare Provider Details

I. General information

NPI: 1053977850
Provider Name (Legal Business Name): GERSON GLUCK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ESPLANADE AVE
BRONX NY
10461-1210
US

IV. Provider business mailing address

1118 ESPLANADE AVE
BRONX NY
10461-1210
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-3663
  • Fax:
Mailing address:
  • Phone: 718-828-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GERSON GLUCK
Title or Position: OWNER
Credential: MD
Phone: 718-828-3663