Healthcare Provider Details

I. General information

NPI: 1801455118
Provider Name (Legal Business Name): BRITTANY LAUREN MILLMAN GLICKBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE STE 200
NEW HYDE PARK NY
11042-1021
US

IV. Provider business mailing address

1999 MARCUS AVE STE 200
NEW HYDE PARK NY
11042-1021
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4600
  • Fax: 516-663-8297
Mailing address:
  • Phone: 516-663-4600
  • Fax: 516-663-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: