Provider Demographics
NPI:1598806077
Name:BONNIE S. GLASSMAN DC PC
Entity Type:Organization
Organization Name:BONNIE S. GLASSMAN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-261-1166
Mailing Address - Street 1:PO BOX 750426
Mailing Address - Street 2:110-27 72 DRIVE
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-0426
Mailing Address - Country:US
Mailing Address - Phone:718-261-1166
Mailing Address - Fax:718-261-1762
Practice Address - Street 1:11027 72ND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5513
Practice Address - Country:US
Practice Address - Phone:718-261-1166
Practice Address - Fax:718-261-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0013488OtherGHI
NYC05691-3OtherWCB
NYX41111OtherBCBS
NY0013488OtherGHI
NYX41111OtherBCBS