Provider Demographics
NPI:1558687731
Name:GLASER, EVELYN SARINA (PNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:SARINA
Last Name:GLASER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2559
Mailing Address - Country:US
Mailing Address - Phone:718-630-6815
Mailing Address - Fax:718-492-5090
Practice Address - Street 1:309 47TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1111
Practice Address - Country:US
Practice Address - Phone:718-492-2234
Practice Address - Fax:718-492-1483
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382104363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics