Provider Demographics
NPI:1619050994
Name:GLASSMAN, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FRANKLIN TPKE STE 216
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1325
Mailing Address - Country:US
Mailing Address - Phone:845-548-6412
Mailing Address - Fax:845-215-0600
Practice Address - Street 1:345 RTE 17 STE 5
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2307
Practice Address - Country:US
Practice Address - Phone:845-548-6412
Practice Address - Fax:845-215-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08029800207R00000X
NY167253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01216600Medicaid
NY36E611Medicare ID - Type Unspecified
NY01216600Medicaid