MEDICARE: ROBERT GLADSTONE DC

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
1	111N00000X	Chiropractor	X39745	NY

General Provider Information

NPI Number	:	1467643973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GLADSTONE DC

Provider Business Mailing Address
First Line	:	2474 NEW YORK AVE
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-1109
Country	:	US
Telephone Number	:	516-721-8720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2474 NEW YORK AVE
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-1109
Country	:	US
Telephone Number	:	516-721-8720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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