Healthcare Provider Details

I. General information

NPI: 1114911419
Provider Name (Legal Business Name): SHARON A. GLICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE SUITE H
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 1262
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1229
  • Fax: 718-270-2794
Mailing address:
  • Phone: 718-270-8867
  • Fax: 718-270-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number197400-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: