Provider Demographics
NPI:1649213323
Name:GLANZ, SIDNEY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:GLANZ
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:PO BOX 95000-5560
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-5560
Mailing Address - Country:US
Mailing Address - Phone:888-220-1235
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 10 LOWER LEVEL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-4510
Practice Address - Fax:516-663-3698
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1181412085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612051Medicaid
NYSG017A9330Medicare PIN
NY17A933Medicare PIN
NY300016283Medicare PIN
NY00612051Medicaid