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NPI Code Detail

MEDICARE: DR. KYLE JORDAN GLITHERO M.D.

MEDICARE: DR. KYLE JORDAN GLITHERO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0120XPediatric Surgery Physician297239NY
2208600000XSurgery Physician297239NY

General Provider Information

NPI Number : 1063701498
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE JORDAN GLITHERO M.D.
Provider Business Mailing Address
First Line : 4802 10TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-2916
Country : US
Telephone Number : 718-283-6000
Fax Number :
Provider Business Practice Location Address
First Line : 4802 10TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-2916
Country : US
Telephone Number : 718-283-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2011
Last Update Date : 12/08/2025

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