Healthcare Provider Details

I. General information

NPI: 1285618926
Provider Name (Legal Business Name): PAUL GLIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019
US

IV. Provider business mailing address

PO BOX 54677
LOS ANGELES CA
90054-0677
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-7165
  • Fax: 212-523-8189
Mailing address:
  • Phone: 800-331-9294
  • Fax: 812-471-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number158603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: