Provider Demographics
NPI:1326123191
Name:GLICKLICH, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:GLICKLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4465 DOUGLAS AVE
Mailing Address - Street 2:#5G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3519
Mailing Address - Country:US
Mailing Address - Phone:718-920-5159
Mailing Address - Fax:
Practice Address - Street 1:MMC - DEPT. OF MEDICINE
Practice Address - Street 2:111 EAST 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY139525207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology