Healthcare Provider Details

I. General information

NPI: 1619050994
Provider Name (Legal Business Name): CHARLES F GLASSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 RTE 17 STE 5
UPPER SADDLE RIVER NJ
07458-2307
US

IV. Provider business mailing address

115 FRANKLIN TPKE STE 216
MAHWAH NJ
07430-1325
US

V. Phone/Fax

Practice location:
  • Phone: 845-548-6412
  • Fax: 845-215-0600
Mailing address:
  • Phone: 845-548-6412
  • Fax: 845-215-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08029800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number167253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: