Provider Demographics
NPI:1699835751
Name:GLENN SCHROYER, MD PLLC
Entity Type:Organization
Organization Name:GLENN SCHROYER, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHROYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-562-2009
Mailing Address - Street 1:20 GLEN DR
Mailing Address - Street 2:STE 2
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2237
Mailing Address - Country:US
Mailing Address - Phone:518-562-2009
Mailing Address - Fax:518-562-2119
Practice Address - Street 1:1785 MILITARY TPKE
Practice Address - Street 2:SUITE 14
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7704
Practice Address - Country:US
Practice Address - Phone:518-562-2009
Practice Address - Fax:518-562-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056839Medicaid
NY02056839Medicaid