Provider Demographics
NPI:1366470213
Name:GOLDFINGER, GLENN HARRIS (PT)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:HARRIS
Last Name:GOLDFINGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 76TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2811
Mailing Address - Country:US
Mailing Address - Phone:212-628-3192
Mailing Address - Fax:212-628-3215
Practice Address - Street 1:133 E 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0317
Practice Address - Country:US
Practice Address - Phone:212-249-5485
Practice Address - Fax:212-249-5486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002535-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C6783OtherPHS
NYQO1762Medicare ID - Type Unspecified