Provider Demographics
NPI:1154634558
Name:GLUCK, DORA LINDA
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:LINDA
Last Name:GLUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1432
Mailing Address - Country:US
Mailing Address - Phone:516-239-1562
Mailing Address - Fax:718-263-1156
Practice Address - Street 1:8 REGENT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1432
Practice Address - Country:US
Practice Address - Phone:516-239-1562
Practice Address - Fax:718-263-1156
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001010-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics