Provider Demographics
NPI:1750333498
Name:HAMMER, GLENN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:S
Last Name:HAMMER
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 1:1100 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1202
Mailing Address - Country:US
Mailing Address - Phone:212-427-9862
Mailing Address - Fax:
Practice Address - Street 1:1100 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1202
Practice Address - Country:US
Practice Address - Phone:212-427-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106623-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541819Medicaid
NY1C0346OtherHEALTHNET PROVIDER NUMBER
NYNS534OtherOXFORD PROVIDER NUMBER
NY0038562OtherGHI PROVIDER NUMBER
NY000147140OtherBLUE CROSS PROVIDER NUMBE
NY165959OtherELDER PLAN PROVIDER NUMBE
NYNS534OtherOXFORD PROVIDER NUMBER
NY00541819Medicaid
NYNS534OtherOXFORD PROVIDER NUMBER