Provider Demographics
NPI:1083637508
Name:GLEYZER, MIKHAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:GLEYZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2404
Mailing Address - Country:US
Mailing Address - Phone:718-382-8642
Mailing Address - Fax:
Practice Address - Street 1:114 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4245
Practice Address - Country:US
Practice Address - Phone:646-398-7486
Practice Address - Fax:646-398-7532
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228820207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07767Medicare ID - Type Unspecified
NYI06292Medicare UPIN