Provider Demographics
NPI:1083753974
Name:GLASSMAN PLASTIC SURGERY,PLLC
Entity Type:Organization
Organization Name:GLASSMAN PLASTIC SURGERY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-354-7878
Mailing Address - Street 1:978 ROUTE 45
Mailing Address - Street 2:SUITE L-5
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3521
Mailing Address - Country:US
Mailing Address - Phone:845-354-7878
Mailing Address - Fax:845-354-7880
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE L-5
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-354-7878
Practice Address - Fax:845-354-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13954012082S0105X
NY16364412082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86851Medicare UPIN