Provider Demographics
NPI:1508990482
Name:GLASSMAN, NOAH SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:SAMUEL
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BLEECKER ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4106
Mailing Address - Country:US
Mailing Address - Phone:212-255-7220
Mailing Address - Fax:212-255-7220
Practice Address - Street 1:289 BLEECKER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4106
Practice Address - Country:US
Practice Address - Phone:212-255-7220
Practice Address - Fax:212-255-7220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV72081Medicare ID - Type Unspecified