MEDICARE: DR. JEROME B GLASSMITH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	2400	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ACCESS 931365	OTHER	NY	HEALTHNET
3	P62577571	OTHER	NY	MULTIPLAN
4	002400A39	OTHER	NY	HEALTHFIRST
5	825983	OTHER	NY	PENNSYLVANIA BLUE SHIELD
6	P030002400NY01	OTHER	NY	ANTHEM 6450
7	P463339	OTHER	NY	OXFORD
8	177233	OTHER	NY	ELDERPLAN
9	24409	OTHER	NY	VITRA
10	36528P	OTHER	NY	HIP
11	4809110772	OTHER	NY	RR MCR
12	4C4625	OTHER	NY	PHS
13	1870	OTHER	NY	MAGNAHEALTH
14	GJ2400	OTHER	NY	ATLANTIS HEALTH
15	P27721	OTHER	NY	BLUE CROSS BLUE SHIELD
16	0086040	OTHER	NY	GHI

General Provider Information

NPI Number	:	1396874343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME B GLASSMITH DPM

Provider Business Mailing Address
First Line	:	4105 31ST AVENUE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3462
Country	:	US
Telephone Number	:	718-278-8020
Fax Number	:	718-278-8599

Provider Business Practice Location Address
First Line	:	4105 31ST AVENUE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3462
Country	:	US
Telephone Number	:	718-278-8020
Fax Number	:	718-278-8599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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