# ACTIVE MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952859746
- **Authorized official:** DAVID A GLUCK MD (PRESIDENT)
- **Authorized official phone:** (718) 878-2224

## Contact information

- **Practice address:** 43-44 KISSENA BLVD,, SUITE LA, FLUSHING, NY 11355
- **Practice address phone:** (718) 878-2224
- **Mailing address:** PO BOX 528160, FLUSHING, NY 11352

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 108577 | NY | Yes |

## Other

- **Enumeration date:** 09/21/2016
- **Last updated:** 09/21/2016