Healthcare Provider Details

I. General information

NPI: 1104915230
Provider Name (Legal Business Name): ROBERT STUART GLICKMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FIRST AVE SUITE 9Q NYU MEDICAL CENTER
NEW YORK CITY NY
10016
US

IV. Provider business mailing address

530 FIRST AVE SUITE 9Q NYU MEDICAL CENTER
NEW YORK CITY NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7552
  • Fax: 212-995-4920
Mailing address:
  • Phone: 212-263-7552
  • Fax: 212-995-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034185-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: