Provider Demographics
NPI:1841287059
Name:GLICKMAN, LEWIS (MD)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PROSPECT PARK W
Mailing Address - Street 2:STE 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1706
Mailing Address - Country:US
Mailing Address - Phone:718-638-0139
Mailing Address - Fax:
Practice Address - Street 1:27 PROSPECT PARK W
Practice Address - Street 2:STE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1706
Practice Address - Country:US
Practice Address - Phone:718-638-0139
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY76014OtherLICENSE
272831Medicare ID - Type Unspecified
NY76014OtherLICENSE