Healthcare Provider Details

I. General information

NPI: 1891854980
Provider Name (Legal Business Name): DR AMY GLASER DR PHILIPPA GORDON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 8TH AVE
BROOKLYN NY
11217-3901
US

IV. Provider business mailing address

33 8TH AVE
BROOKLYN NY
11217-3901
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-0999
  • Fax: 718-636-3951
Mailing address:
  • Phone: 718-636-0999
  • Fax: 718-636-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number145235
License Number StateNY

VIII. Authorized Official

Name: JOANNE TRIMARCO
Title or Position: OFFICE MANGER
Credential:
Phone: 17186360999