Provider Demographics
NPI:1821169921
Name:GLOVINSKY, PAUL BENJAMIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENJAMIN
Last Name:GLOVINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 13TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7803
Mailing Address - Country:US
Mailing Address - Phone:212-832-1526
Mailing Address - Fax:518-464-9650
Practice Address - Street 1:175 W 13TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7803
Practice Address - Country:US
Practice Address - Phone:212-832-1526
Practice Address - Fax:518-464-9650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008914103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV40311Medicare ID - Type Unspecified
NYR53271Medicare UPIN