Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 034185-1 | NY |
NPI | 1104915230 |
---|---|
Provider Name | Dr. Robert Stuart Glickman |
First Address | New York City, NY 10016 |
Second Address | New York City, NY 10016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072977 | (05) | NY |
U29117 | (02) | NY |