=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952732752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WANDA RACHEL GLINERT M.S.ED.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2013
-----------------------------------------------------
Last Update Date | 12/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W 70TH ST APT. 18H
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-207-2741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W 70TH ST APT 18H
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-207-2741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1227088
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------