Provider Demographics
NPI:1780045005
Name:GLUCKSMAN, SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GLUCKSMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HILLELSOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVE STE M18
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1023
Mailing Address - Country:US
Mailing Address - Phone:917-952-5586
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE STE M18
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-466-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0752399363LF0000X
NY709740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse