Provider Demographics
NPI:1114911419
Name:GLICK, SHARON A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:A
Last Name:GLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 1262
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-8867
Mailing Address - Fax:718-270-1794
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUITE H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1229
Practice Address - Fax:718-270-2794
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2015-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY197400-1207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01840362Medicaid
NYG41885Medicare UPIN
NY01840362Medicaid