Provider Demographics
NPI:1013121656
Name:NOAM GLASER, M.D. PC
Entity Type:Organization
Organization Name:NOAM GLASER, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-799-0210
Mailing Address - Street 1:727 N BROADWAY
Mailing Address - Street 2:SUITE C2
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:516-799-0210
Mailing Address - Fax:516-799-0247
Practice Address - Street 1:727 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:516-799-0210
Practice Address - Fax:516-799-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLP931Medicare PIN