MEDICARE: GLENN GILBERG PA

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	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	006260	NY

General Provider Information

NPI Number	:	1770603755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN GILBERG PA

Provider Business Mailing Address
First Line	:	17 LANSING ST
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1983
Country	:	US
Telephone Number	:	315-255-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	6870 E GENESEE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1031
Country	:	US
Telephone Number	:	315-679-4367
Fax Number	:	315-679-4368

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

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	09/12/2025

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Directions to “ GLENN GILBERG PA” Practice Location

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