| Doctor Name: | ROSALYN GLICKLICH |
| NPI Number: | 1629423843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 75-59 263rd St. Glen Oaks, NY - 11004 |
| Business Phone Number: | 9142554624 |
| Business Fax Number: | |
| Mailing Address: | 129 Jefferson Ave, Apt 2 BROOKLYN |
| State: | NY |
| Postal Code: | 112162392 |
| Phone Number: | 9142554624 |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2016 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |