Individual provider Active NPI

Maksim Glezer, RPH

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1033157201
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
048465 Issued in NY
Practice address
119 Church Ave
Brooklyn, NY 11218-3917
Phone
(718) 686-7343
Fax
(718) 686-7492
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 048465 NY Primary

Addresses

Primary practice location

119 Church Ave
Brooklyn, NY 11218-3917

Mailing address

119 Church Ave
Brooklyn, NY 11218-3917
Phone (718) 686-7343

Other identifiers 1

IdentifierTypeStateIssuer
02368656MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
048465NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Interboro Pharmacy Inc. Current Accepting new patients
Image Prescription Center LTC Current Accepting new patients
MBG Pharmacy Corp Current Accepting new patients

Locations

119 Church Ave
Brooklyn, NY 11218
Phone (718) 436-1848

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033157201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112183917",
            "telephone_number": "718-686-7343",
            "fax_number": "718-686-7492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112183917",
            "telephone_number": "718-686-7343",
            "fax_number": "718-686-7492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLEZER",
        "first_name": "MAKSIM",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "048465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02368656",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.