Provider Demographics
NPI:1053447375
Name:GLASER, LAWRENCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PERCY WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2222
Mailing Address - Country:US
Mailing Address - Phone:631-277-7296
Mailing Address - Fax:631-277-7296
Practice Address - Street 1:70 PERCY WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2222
Practice Address - Country:US
Practice Address - Phone:631-277-7296
Practice Address - Fax:631-277-7296
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY293231OtherBLUE CROSS-BLUE SHIELD
NY29323100Medicare ID - Type Unspecified