Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 228820 | NY |
Y | 207Q00000X | Family Doctor | 228820 | NY |
NPI | 1083637508 |
---|---|
Provider Name | Dr. Mikhail Gleyzer |
First Address | Brooklyn, NY 11235-2404 |
Second Address | Glendale, NY 11385-7267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 06/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06292 | (02) | NY |