1386646842 NPI number — FRANCES L GLICKSMAN MD

Table of content: FRANCES L GLICKSMAN MD (NPI 1386646842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386646842 NPI number — FRANCES L GLICKSMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLICKSMAN
Provider First Name:
FRANCES
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386646842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
09/19/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CHIPPEWA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFERN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-793-7049
Provider Business Mailing Address Fax Number:
305-674-1890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 ALTON RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-674-1887
Provider Business Practice Location Address Fax Number:
305-674-1890
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0051210 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 157528-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 057769300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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