Provider Demographics
NPI:1043550478
Name:DR. JEFFREY GLEIBERMAN PA
Entity Type:Organization
Organization Name:DR. JEFFREY GLEIBERMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLEIBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-883-1664
Mailing Address - Street 1:54 CURTISS PKWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5219
Mailing Address - Country:US
Mailing Address - Phone:305-883-1664
Mailing Address - Fax:305-883-3306
Practice Address - Street 1:54 CURTISS PKWY
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5219
Practice Address - Country:US
Practice Address - Phone:305-883-1664
Practice Address - Fax:305-883-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1646261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620244600Medicaid
FLU06394Medicare UPIN
FL620244600Medicaid