Provider Demographics
NPI:1144849738
Name:CENTER FOR NEUROSURGERY(GLICKMAN) PLLC
Entity type:Organization
Organization Name:CENTER FOR NEUROSURGERY(GLICKMAN) PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-803-2672
Mailing Address - Street 1:42 BUSINESS CENTRE DR UNIT 310
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-6995
Mailing Address - Country:US
Mailing Address - Phone:850-803-2672
Mailing Address - Fax:850-600-2675
Practice Address - Street 1:42 BUSINESS CENTRE DR UNIT 310
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6995
Practice Address - Country:US
Practice Address - Phone:850-803-2672
Practice Address - Fax:850-600-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty