MEDICARE: DR. MICHAEL PETER GLICK

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	207RG0100X	Gastroenterology Physician	257932	NY

General Provider Information

NPI Number	:	1659532802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PETER GLICK

Provider Business Mailing Address
First Line	:	535 5TH AVE
Second Line	:	SUITE 611
City	:	NEW YORK
State	:	NY
Zip	:	10017-3620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 5TH AVE
Second Line	:	SUITE 611
City	:	NEW YORK
State	:	NY
Zip	:	10017-3620
Country	:	US
Telephone Number	:	212-227-3688
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	01/05/2016

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Directions to “ DR. MICHAEL PETER GLICK ” Practice Location

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