Individual
LISA L GLUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
148 DOUGHTY BLVD, SUITE 250, INWOOD, NY 11096-2080
(516) 295-4708
(516) 295-3191
Mailing address
148 DOUGHTY BLVD, SUITE 250, INWOOD, NY 11096-2080
(516) 295-4708
(516) 295-3191
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P3694131
OXFORD
NY
Enumeration date
04/03/2008
Last updated
04/03/2008
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