Provider Demographics
NPI:1467429027
Name:GLICKSMAN, CAROLINE (MDFACS)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:GLICKSMAN
Suffix:
Gender:F
Credentials:MDFACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1013
Mailing Address - Country:US
Mailing Address - Phone:732-974-2424
Mailing Address - Fax:732-974-0134
Practice Address - Street 1:2164 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-2424
Practice Address - Fax:732-974-0134
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56647208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE99398Medicare UPIN