Provider Demographics
NPI:1902196066
Name:GLICK, ALEXANDER F (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:F
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:462 1ST AVE BLDG A314A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-2455
Mailing Address - Fax:212-562-5518
Practice Address - Street 1:462 1ST AVE BLDG A314A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-2455
Practice Address - Fax:212-562-5518
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics