Provider Demographics
NPI:1568638831
Name:GLEICHER, NEIL H
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:H
Last Name:GLEICHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SOUTH 4TH ST
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:718-384-4700
Mailing Address - Fax:
Practice Address - Street 1:225 SO 4TH ST
Practice Address - Street 2:BKLYN
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:718-384-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003150-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01956330Medicaid