Provider Demographics
NPI:1538390976
Name:GLUZMAN, YAACOV
Entity type:Individual
Prefix:
First Name:YAACOV
Middle Name:
Last Name:GLUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 CONEY ISLAND AVE
Mailing Address - Street 2:# 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3308
Mailing Address - Country:US
Mailing Address - Phone:718-578-3113
Mailing Address - Fax:
Practice Address - Street 1:1300 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1106
Practice Address - Country:US
Practice Address - Phone:718-954-3800
Practice Address - Fax:718-954-3767
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)