MEDICARE: DR AMY GLASER DR PHILIPPA GORDON

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	208000000X	Pediatrics Physician	145235	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962586719	OTHER	NY	DR PHILIPPA GORDON NPI #
2	1972688026	OTHER	NY	DR AMY GLASER NPI #

General Provider Information

NPI Number	:	1891854980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR AMY GLASER DR PHILIPPA GORDON

Provider Business Mailing Address
First Line	:	33 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3901
Country	:	US
Telephone Number	:	718-636-0999
Fax Number	:	718-636-3951

Provider Business Practice Location Address
First Line	:	33 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3901
Country	:	US
Telephone Number	:	718-636-0999
Fax Number	:	718-636-3951

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	JOANNE TRIMARCO
Credential	:
Telephone Number	:	17186360999

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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