Provider Demographics
NPI:1174847479
Name:GLUCKMAN, CHAYA Z (OTR)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:Z
Last Name:GLUCKMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4730
Mailing Address - Country:US
Mailing Address - Phone:718-951-8800
Mailing Address - Fax:718-951-0846
Practice Address - Street 1:2555 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4730
Practice Address - Country:US
Practice Address - Phone:718-951-8800
Practice Address - Fax:718-951-0846
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016052OtherLICENSE#