Myron Lawrence Glucksman, MD
Individual provider Active NPI Psychiatry Physician · West Redding, CT
NPI 1215968482 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215968482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 14618 (CT)
- Practice address
- 68 Marchant Rd
West Redding, CT 06896-1823 - Phone
- (203) 938-1188
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2015 through Jan 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14618 | CT | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 14618 | CT | Yes |
Addresses
Primary practice location
68 Marchant Rd
West Redding, CT 06896-1823
Mailing address
68 Marchant Rd
West Redding, CT 06896-1823
Phone (203) 938-1188
Other providers in West Redding, CT
All providers in West Redding, CT · Psychiatry Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.