Provider Demographics
NPI:1053596841
Name:ROBERT I. GLUCK, MD, LLC
Entity type:Organization
Organization Name:ROBERT I. GLUCK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-280-5844
Mailing Address - Street 1:410 LAKEVILLE ROAD
Mailing Address - Street 2:SUITE310
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-280-5844
Mailing Address - Fax:516-280-5768
Practice Address - Street 1:410 LAKEVILLE ROAD
Practice Address - Street 2:SUITE310
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-280-5844
Practice Address - Fax:516-280-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155436332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01181442Medicaid
NY01181442Medicaid
NYE50448Medicare UPIN