| NPI | 1104848811 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2006-07-24 |
| Last Updated | 2025-12-10 |
| Mailing Address | 2792 Ocean Ave Fl 2 Brooklyn, NY 11229-4731 United States Phone: (833) 635-2566 | Fax: (833) 635-2566 📍 View Map |
| Primary Practice Address | 640 Hawkins Ave Lake Ronkonkoma, NY 11779-2324 United States Phone: (631) 737-0100 | Fax: (631) 417-1117 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | NY | 01850673 | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 207N00000X – Dermatology | NY | 143678 |
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About NPI 1104848811
Michael Gladstein MD is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1104848811. The primary specialty listed is Dermatology. The provider is located in Lake Ronkonkoma, NY. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-07-24. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1104848811?
NPI 1104848811 belongs to Michael Gladstein MD, a Dermatology in Lake Ronkonkoma, NY. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1104848811 active?
The current status of NPI 1104848811 in the NPPES registry is Active. The record was last updated on 2025-12-10.
What specialty is NPI 1104848811?
NPI 1104848811 is classified under the taxonomy Dermatology. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1104848811?
You can verify NPI 1104848811 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1104848811?
The primary practice address on file for NPI 1104848811 is 640 Hawkins Ave, Lake Ronkonkoma, NY 11779-2324. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1104848811 issued?
NPI 1104848811 was first issued (enumerated) on 2006-07-24. The NPPES record was last updated on 2025-12-10.
Practice Location Map
Michael Gladstein is located at 640 Hawkins Ave, Lake Ronkonkoma, NY. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Michael Gladstein. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1104848811. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Dermatology | 143678 | NY |