MEDICARE: ELMHURST WOMEN'S MEDICAL, PC

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	207VG0400X	Gynecology Physician	108577	NY

General Provider Information

NPI Number	:	1558503938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMHURST WOMEN'S MEDICAL, PC

Provider Business Mailing Address
First Line	:	4024 76TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1009
Country	:	US
Telephone Number	:	718-205-3550
Fax Number	:	718-205-3540

Provider Business Practice Location Address
First Line	:	4024 76TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1009
Country	:	US
Telephone Number	:	718-205-3550
Fax Number	:	718-205-3540

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAVID A GLUCK
Credential	:	M.D.
Telephone Number	:	718-205-3550

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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