Provider Demographics
NPI:1033157201
Name:GLEZER, MAKSIM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAKSIM
Middle Name:
Last Name:GLEZER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3917
Mailing Address - Country:US
Mailing Address - Phone:718-686-7343
Mailing Address - Fax:718-686-7492
Practice Address - Street 1:119 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3917
Practice Address - Country:US
Practice Address - Phone:718-686-7343
Practice Address - Fax:718-686-7492
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02368656Medicaid
NY4708250001Medicare ID - Type Unspecified