Provider Demographics
NPI:1710249404
Name:GLAIZER, JULIA (MSED)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:GLAIZER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MARYLAND AVE
Mailing Address - Street 2:#2C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2973
Mailing Address - Country:US
Mailing Address - Phone:718-864-0430
Mailing Address - Fax:718-420-9938
Practice Address - Street 1:410 MARYLAND AVE
Practice Address - Street 2:#2C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2973
Practice Address - Country:US
Practice Address - Phone:718-864-0430
Practice Address - Fax:718-420-9938
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY828916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist