1083753974 NPI number — GLASSMAN PLASTIC SURGERY,PLLC

Table of content: UYOYO OMADUVIE MD (NPI 1851955447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083753974 NPI number — GLASSMAN PLASTIC SURGERY,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASSMAN PLASTIC SURGERY,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1083753974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
978 ROUTE 45
Provider Second Line Business Mailing Address:
SUITE L-5
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10970-3521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-354-7878
Provider Business Mailing Address Fax Number:
845-354-7880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
978 ROUTE 45
Provider Second Line Business Practice Location Address:
SUITE L-5
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-354-7878
Provider Business Practice Location Address Fax Number:
845-354-7880
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GLASSMAN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
845-354-7878

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X , with the licence number:  1395401 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0105X , with the licence number: 1636441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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