Provider Demographics
NPI:1003020033
Name:MANCHER, GLENN (MS)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:MANCHER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4414
Mailing Address - Country:US
Mailing Address - Phone:718-333-2500
Mailing Address - Fax:718-333-2835
Practice Address - Street 1:2501 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4414
Practice Address - Country:US
Practice Address - Phone:718-333-2500
Practice Address - Fax:718-333-2835
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011955OtherLICENSE
NYA400017742Medicare PIN