Provider Demographics
NPI:1841294626
Name:GLUCK, HONI L (MD)
Entity type:Individual
Prefix:
First Name:HONI
Middle Name:L
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLAZA ST W APT 12B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3741
Mailing Address - Country:US
Mailing Address - Phone:910-850-3059
Mailing Address - Fax:
Practice Address - Street 1:BRONX PSYCHIATRIC CENTER
Practice Address - Street 2:1500 WATERS PLACE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:929-348-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2798822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935831Medicaid
NC2188863AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NCF61124Medicare UPIN