Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 028331-1 | NY |
NPI | 1114077989 |
---|---|
Provider Name | Dr. Harvey Glicker |
First Address | New Hyde Park, NY 11040-2513 |
Second Address | New Hyde Park, NY 11040-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |