1699932343 NPI number — DR. SIDNEY GLASOFER MD

Table of content: DR. SIDNEY GLASOFER MD (NPI 1699932343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699932343 NPI number — DR. SIDNEY GLASOFER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASOFER
Provider First Name:
SIDNEY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699932343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416457
Provider Second Line Business Mailing Address:
PRACTICE ASSOCIATES MEDICAL GROUP
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-656-6280
Provider Business Mailing Address Fax Number:
973-290-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 CENTRAL AVE STE 115
Provider Second Line Business Practice Location Address:
ASSOCIATES INCARDIOVASCULAR DISEASE, LLC
Provider Business Practice Location Address City Name:
NEW PROVIDENCE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07974-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-464-4200
Provider Business Practice Location Address Fax Number:
908-464-1332
Provider Enumeration Date:
05/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  239426 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 25MA08526500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0267813 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com