Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02410900 | NJ |
NPI | 1053544361 |
---|---|
Provider Name | Dr. Talya Gluck |
First Address | Newark, NJ 07103-2495 |
Second Address | Newark, NJ 07103-2495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2009 |
Last Update Date | 02/09/2009 |