Provider Demographics
NPI:1841852647
Name:GLASER, ELLA (MD)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:GLASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E 29TH ST APT 19A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7952
Mailing Address - Country:US
Mailing Address - Phone:314-440-1551
Mailing Address - Fax:
Practice Address - Street 1:130 E 18TH ST LBBY 1U
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2416
Practice Address - Country:US
Practice Address - Phone:212-674-0004
Practice Address - Fax:917-677-8525
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322708207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty