Provider Demographics
NPI:1245559731
Name:GLIBICKY, MARINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:GLIBICKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ROUTE 59 STE 302
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5208
Mailing Address - Country:US
Mailing Address - Phone:845-368-0100
Mailing Address - Fax:845-368-3855
Practice Address - Street 1:222 ROUTE 59 STE 302
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5208
Practice Address - Country:US
Practice Address - Phone:845-368-0100
Practice Address - Fax:845-368-3855
Is Sole Proprietor?:No
Enumeration Date:2010-05-23
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110968207R00000X
NJ25MA08759300207R00000X
NY259988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine