Provider Demographics
NPI:1477611101
Name:GLASSER, STEVEN J (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:GLASSER
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 1:73 NORTH WATER STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5815
Mailing Address - Country:US
Mailing Address - Phone:203-531-9354
Mailing Address - Fax:203-531-5133
Practice Address - Street 1:73 NORTH WATER STREET
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5815
Practice Address - Country:US
Practice Address - Phone:203-531-9354
Practice Address - Fax:203-531-5133
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22774207R00000X
NY1410471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001227743Medicaid
D02724Medicare UPIN
CT001227743Medicaid
NY42C121Medicare PIN