Provider Demographics
NPI:1407935117
Name:GLASER, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GLASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 WALDO AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3933
Mailing Address - Country:US
Mailing Address - Phone:718-549-7400
Mailing Address - Fax:718-543-2063
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:ROOM BHN 106 NY PRESBYTERIAN HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:718-549-7400
Practice Address - Fax:718-543-2063
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY095117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00157231Medicaid
1C0079OtherPHS
573941OtherEMPIRE BS
573942OtherEMPIRE BS