Provider Demographics
NPI:1568486892
Name:GLUCK, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GLUCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 5TH AVE
Mailing Address - Street 2:1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7605
Mailing Address - Country:US
Mailing Address - Phone:212-924-2094
Mailing Address - Fax:
Practice Address - Street 1:96 5TH AVE
Practice Address - Street 2:1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7605
Practice Address - Country:US
Practice Address - Phone:212-924-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02560305Medicaid
NYVM5311Medicare PIN