Provider Demographics
NPI:1124079025
Name:GLENN S. HAMMER, M.D., P.C.
Entity type:Organization
Organization Name:GLENN S. HAMMER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-427-9550
Mailing Address - Street 1:1100 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1202
Mailing Address - Country:US
Mailing Address - Phone:212-427-9550
Mailing Address - Fax:212-427-9889
Practice Address - Street 1:1100 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1202
Practice Address - Country:US
Practice Address - Phone:212-427-9550
Practice Address - Fax:212-427-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01119346Medicaid
NY01119346Medicaid
NY=========OtherTAX IDENTIFICATION NUMBER