Healthcare Provider Details

I. General information

NPI: 1083637508
Provider Name (Legal Business Name): MIKHAIL GLEYZER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 72ND ST
NEW YORK NY
10021-4245
US

IV. Provider business mailing address

2426 E 26TH ST
BROOKLYN NY
11235-2404
US

V. Phone/Fax

Practice location:
  • Phone: 646-398-7486
  • Fax: 646-398-7532
Mailing address:
  • Phone: 718-382-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number228820
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number228820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: