Healthcare Provider Details

I. General information

NPI: 1922500818
Provider Name (Legal Business Name): EMANUEL GLUCKMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 57TH ST STE 815
NEW YORK NY
10019-2401
US

IV. Provider business mailing address

45 ASPEN DR
CEDAR GROVE NJ
07009-2304
US

V. Phone/Fax

Practice location:
  • Phone: 212-974-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number062158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: