1225271711 NPI number — J.L.GLASHOW M.D.,P.C.

Table of content: (NPI 1225271711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225271711 NPI number — J.L.GLASHOW M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.L.GLASHOW M.D.,P.C.
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:
6
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:
1225271711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 E 74TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-3249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-794-5096
Provider Business Mailing Address Fax Number:
212-570-1507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 PARK AVE STE 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-794-5096
Provider Business Practice Location Address Fax Number:
212-570-1507
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCSORLEY
Authorized Official First Name:
CARRIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
914-669-6085

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163027 . This is a "WORKERS COPENSATIO NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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