Provider Demographics
NPI:1770726606
Name:GLICK, ZOEY ROSE (MD AS OF 5/17/09)
Entity type:Individual
Prefix:
First Name:ZOEY
Middle Name:ROSE
Last Name:GLICK
Suffix:
Gender:F
Credentials:MD AS OF 5/17/09
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1000
Mailing Address - Fax:
Practice Address - Street 1:425 ESSJAY RD STE 130
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5782
Practice Address - Country:US
Practice Address - Phone:716-656-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30463207N00000X
390200000X
NY300835207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program