Healthcare Provider Details

I. General information

NPI: 1467988774
Provider Name (Legal Business Name): GLASS PODIATRIC FOOT OBS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE SUITE 2301
NEW YORK NY
10017-5405
US

IV. Provider business mailing address

315 MADISON AVE SUITE 2301
NEW YORK NY
10017-5405
US

V. Phone/Fax

Practice location:
  • Phone: 212-867-2500
  • Fax: 212-867-3845
Mailing address:
  • Phone: 212-867-2500
  • Fax: 212-867-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006132
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW GLASS
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 212-867-2500