Provider Demographics
NPI:1578970349
Name:GLUZMAN, NELLI (DO)
Entity Type:Individual
Prefix:DR
First Name:NELLI
Middle Name:
Last Name:GLUZMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6954
Mailing Address - Country:US
Mailing Address - Phone:201-632-3060
Mailing Address - Fax:973-954-2977
Practice Address - Street 1:113 MONROE ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6954
Practice Address - Country:US
Practice Address - Phone:201-632-3060
Practice Address - Fax:973-954-2977
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275398208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03917291Medicaid