Provider Demographics
NPI:1760474449
Name:GLICKMAN, ALAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 ALBANY POST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1766
Mailing Address - Country:US
Mailing Address - Phone:845-430-6287
Mailing Address - Fax:
Practice Address - Street 1:4250 ALBANY POST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1766
Practice Address - Country:US
Practice Address - Phone:845-229-2602
Practice Address - Fax:845-229-2830
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334262-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02575331Medicaid
NYQ14916Medicare UPIN
NYO558G1Medicare ID - Type Unspecified