Provider Demographics
NPI:1851391163
Name:GLASSMAN, MARK S (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-594-4610
Mailing Address - Fax:914-594-4392
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-594-4610
Practice Address - Fax:914-594-4392
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-09-26
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Provider Licenses
StateLicense IDTaxonomies
NY1578112080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00867643Medicaid
CT001242700Medicaid
NY00867643Medicaid
NY05D191Medicare PIN