Provider Demographics
NPI:1134481617
Name:GLUCK, TZIVIE (MSED)
Entity Type:Individual
Prefix:
First Name:TZIVIE
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4506
Mailing Address - Country:US
Mailing Address - Phone:347-524-4204
Mailing Address - Fax:
Practice Address - Street 1:1127 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4506
Practice Address - Country:US
Practice Address - Phone:347-524-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536097041174400000X
NY448533041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist