Healthcare Provider Details

I. General information

NPI: 1689661464
Provider Name (Legal Business Name): BARRY STEPHEN GLOGER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 AUSTIN ST STE 124
FOREST HILLS NY
11375-5354
US

IV. Provider business mailing address

7211 AUSTIN ST STE 124
FOREST HILLS NY
11375-5354
US

V. Phone/Fax

Practice location:
  • Phone: 718-643-1836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number135225
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number135225
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number135225
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number135225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: