Provider Demographics
NPI:1851517122
Name:GLENN E. OSTRIKER, M.D.
Entity Type:Organization
Organization Name:GLENN E. OSTRIKER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:OSTRIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-348-6300
Mailing Address - Street 1:71 STRAWBERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2757
Mailing Address - Country:US
Mailing Address - Phone:203-348-6300
Mailing Address - Fax:203-971-0710
Practice Address - Street 1:71 STRAWBERRY HILL AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2757
Practice Address - Country:US
Practice Address - Phone:203-348-6300
Practice Address - Fax:203-971-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26705207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB17897Medicare UPIN
CTC02928Medicare ID - Type UnspecifiedMEDICARE