Provider Demographics
NPI:1225383854
Name:GLANTZ, IDA (SPECIALIST)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101-01 67TH DRIVE APT. 3D
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:917-972-5765
Mailing Address - Fax:
Practice Address - Street 1:10101 67TH DR APT 3D
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2701
Practice Address - Country:US
Practice Address - Phone:917-972-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist