Provider Demographics
NPI:1205019403
Name:SHERRIE GLASSER PHYSICAL THERAPY/JOHN DOUGLAS PTA
Entity Type:Organization
Organization Name:SHERRIE GLASSER PHYSICAL THERAPY/JOHN DOUGLAS PTA
Other - Org Name:METRO COMPREHENSIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:516-454-6387
Mailing Address - Street 1:18 HAMILTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1915
Mailing Address - Country:US
Mailing Address - Phone:516-454-6387
Mailing Address - Fax:516-454-6303
Practice Address - Street 1:5 BROWNS RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767
Practice Address - Country:US
Practice Address - Phone:631-849-6000
Practice Address - Fax:631-849-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005253-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0642670OtherCIGNA
NY6699092OtherGHI
NYA3613201OtherOXFORD
NY76643OtherVYTRA
NY5C7306OtherHEALTHNET
NY021665SOtherHEALTHCARE PARTNERS
NY3422589OtherAETNA
NYAZ00688OtherMDNY
NYQ0WPD1Medicare PIN