Provider Demographics
NPI:1811955602
Name:GLASBERG, SCOT BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:BRADLEY
Last Name:GLASBERG
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 1:42A E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2735
Mailing Address - Country:US
Mailing Address - Phone:212-717-8550
Mailing Address - Fax:212-717-8589
Practice Address - Street 1:42A E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2735
Practice Address - Country:US
Practice Address - Phone:212-717-8550
Practice Address - Fax:212-717-8589
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188514208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854062Medicaid
NYG61064Medicare UPIN
NY29L801Medicare PIN