Provider Demographics
NPI:1003995796
Name:OSTRIKER, GLENN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:OSTRIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:71 STRAWBERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2757
Mailing Address - Country:US
Mailing Address - Phone:203-348-6300
Mailing Address - Fax:203-961-0710
Practice Address - Street 1:71 STRAWBERRY HILL AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2757
Practice Address - Country:US
Practice Address - Phone:203-348-6300
Practice Address - Fax:203-961-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26705207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001267053Medicaid
CT2V2621OtherHEALTHNET
CTZS547OtherOXFORD
CT526705OtherCONNECTICARE
CT26705OtherLICENSE
CT6611458OtherCIGNA
CT010026705CT01OtherANTHEM BC/BS
CT4304779OtherAETNA
CT6611458OtherCIGNA
CT526705OtherCONNECTICARE
CT26705OtherLICENSE