Provider Demographics
NPI:1811199508
Name:GLASSMAN, MELISSA ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELLIS
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIVERSIDE DR
Mailing Address - Street 2:APT. 17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6108
Mailing Address - Country:US
Mailing Address - Phone:212-721-8545
Mailing Address - Fax:
Practice Address - Street 1:575 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5002
Practice Address - Country:US
Practice Address - Phone:212-342-3060
Practice Address - Fax:212-342-6010
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics