Provider Demographics
NPI:1477627040
Name:GLICK, JAMIE FILIP (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:FILIP
Last Name:GLICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:444 W JERICHO TPKE
Mailing Address - Street 2:STE A
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6061
Mailing Address - Country:US
Mailing Address - Phone:631-659-3800
Mailing Address - Fax:631-659-3798
Practice Address - Street 1:444 W JERICHO TPKE
Practice Address - Street 2:STE A
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6061
Practice Address - Country:US
Practice Address - Phone:631-659-3800
Practice Address - Fax:631-659-3798
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0209992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP3331Medicare ID - Type Unspecified