Healthcare Provider Details

I. General information

NPI: 1851093868
Provider Name (Legal Business Name): THOMAS GLAZER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270-05 76TH AVE DEPARTMENT OF EMERGENCY MEDICINE
NEW HYDE PARK NY
11040-1496
US

IV. Provider business mailing address

270-05 76TH AVE DEPARTMENT OF EMERGENCY MEDICINE
NEW HYDE PARK NY
11040-1496
US

V. Phone/Fax

Practice location:
  • Phone: 516-470-7873
  • Fax:
Mailing address:
  • Phone: 516-470-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number335959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: