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General NPI Number Information
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NPI Number | 1801150719
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Entity Type | Organization
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Legal Business Name | D.GLICKMAN, P.A.
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 202
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-239-0578
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Fax | 954-239-0582
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Provider Business Mailing Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 202
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-239-0578
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Fax | 954-239-0582
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CHOLPON SABYROVA
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Credential |
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Telephone | 954-239-0578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS1485
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License Number State | FL
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