Provider Demographics
NPI:1700931359
Name:JORDAN B. GLASER M.D.P.C
Entity Type:Organization
Organization Name:JORDAN B. GLASER M.D.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFECTIOUS DISEASE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:718-816-3362
Mailing Address - Street 1:1408 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2312
Mailing Address - Country:US
Mailing Address - Phone:718-816-3362
Mailing Address - Fax:718-979-4650
Practice Address - Street 1:1408 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2312
Practice Address - Country:US
Practice Address - Phone:718-816-3362
Practice Address - Fax:718-979-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02550172Medicaid
NYWAA231Medicare PIN
NYB80365Medicare UPIN