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General NPI Number Information
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NPI Number | 1558503938
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Entity Type | Organization
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Legal Business Name | ELMHURST WOMEN'S MEDICAL, PC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 4024 76TH ST
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City | ELMHURST
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State | NY
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Zip | 11373-1009
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Country | US
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Telephone | 718-205-3550
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Fax | 718-205-3540
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Provider Business Mailing Address
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Address Line | 4024 76TH ST
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City | ELMHURST
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State | NY
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Zip | 11373-1009
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Country | US
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Telephone | 718-205-3550
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Fax | 718-205-3540
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID A GLUCK
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Credential | M.D.
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Telephone | 718-205-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 108577
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License Number State | NY
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