1073622114 NPI number — DR. ANDREW RIGBY GLASS DPM

Table of content: DR. ANDREW RIGBY GLASS DPM (NPI 1073622114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073622114 NPI number — DR. ANDREW RIGBY GLASS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASS
Provider First Name:
ANDREW
Provider Middle Name:
RIGBY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1073622114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HILLSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-314-6484
Provider Business Mailing Address Fax Number:
212-867-3845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MADISON AVE
Provider Second Line Business Practice Location Address:
RM 2301
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-867-2500
Provider Business Practice Location Address Fax Number:
212-867-2500
Provider Enumeration Date:
08/30/2006

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: 213E00000X , with the licence number:  N006132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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