Provider Demographics
NPI:1386646842
Name:GLICKSMAN, FRANCES L (MD)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:L
Last Name:GLICKSMAN
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 1:5 CHIPPEWA CT
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4158
Mailing Address - Country:US
Mailing Address - Phone:305-793-7049
Mailing Address - Fax:305-674-1890
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-674-1887
Practice Address - Fax:305-674-1890
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2023-08-07
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2007-09-19
Provider Licenses
StateLicense IDTaxonomies
FL0051210207RC0000X
NY157528-01207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057769300Medicaid
FL057769300Medicaid
FL11325YMedicare PIN