Provider Demographics
NPI:1841381373
Name:JEFFERY, GLENN REGINALD (MD)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:REGINALD
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 ALLEN STREET
Mailing Address - Street 2:LOWER EAST SIDE HARM REDUCTION CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-266-6333
Mailing Address - Fax:212-343-8005
Practice Address - Street 1:25 ALLEN STREET
Practice Address - Street 2:LOWER EAST SIDE HARM REDUCTION CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-266-6333
Practice Address - Fax:212-343-8005
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1876492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY0033S231Medicare ID - Type Unspecified
NY00246075Medicaid