Provider Demographics
NPI:1083006704
Name:GLUCK, AMANDA (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1423
Mailing Address - Country:US
Mailing Address - Phone:646-242-8452
Mailing Address - Fax:
Practice Address - Street 1:968 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1423
Practice Address - Country:US
Practice Address - Phone:646-242-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist