Provider Demographics
NPI:1972619245
Name:MIKHAIL GLEYZER OSTEOPATHIC FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:MIKHAIL GLEYZER OSTEOPATHIC FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEYZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-366-2281
Mailing Address - Street 1:2426 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2404
Mailing Address - Country:US
Mailing Address - Phone:718-366-2281
Mailing Address - Fax:718-366-2243
Practice Address - Street 1:6805 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7267
Practice Address - Country:US
Practice Address - Phone:718-366-2281
Practice Address - Fax:718-366-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228820204D00000X, 207Q00000X, 207QS0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07767Medicare PIN
IO6292Medicare UPIN
NY04450JMedicare ID - Type Unspecified