Provider Demographics
NPI:1588658967
Name:GLOCKENBERG, AARON (DPM)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:GLOCKENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6003
Mailing Address - Country:US
Mailing Address - Phone:718-733-1999
Mailing Address - Fax:718-584-3544
Practice Address - Street 1:2445 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6003
Practice Address - Country:US
Practice Address - Phone:718-733-1999
Practice Address - Fax:718-584-3544
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003013213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423432Medicaid
NY0028634OtherGROUP HEALTH INCORPORATED
NYP665624OtherOXFORD
NY1000001488OtherAFFINITY HEALTH PLAN
NY003013-A19OtherHEALTH FIRST
NY10471519OtherHEALTH NET
NY129710101OtherHEALTH PLUS
NY0028634OtherGROUP HEALTH INCORPORATED
NY129710101OtherHEALTH PLUS