Provider Demographics
NPI:1831188424
Name:WURTZEL, GLENN (MS, NP-P, APRN-BC)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:WURTZEL
Suffix:
Gender:M
Credentials:MS, NP-P, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1-O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2605
Mailing Address - Country:US
Mailing Address - Phone:212-988-4704
Mailing Address - Fax:212-988-4706
Practice Address - Street 1:140 RIVERSIDE DR
Practice Address - Street 2:SUITE 1-O
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2605
Practice Address - Country:US
Practice Address - Phone:212-988-4704
Practice Address - Fax:212-988-4706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517707163W00000X
NY400680363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse