Healthcare Provider Details

I. General information

NPI: 1710204748
Provider Name (Legal Business Name): JACOB GLASS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 70TH ST WEILL CORNELL INTERNAL MEDICINE ASSOCIATES, BOX 148
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

505 E 70TH ST WEILL CORNELL INTERNAL MEDICINE ASSOCIATES, BOX 148
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3587
  • Fax: 212-746-4609
Mailing address:
  • Phone: 212-746-3587
  • Fax: 212-746-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNOT APPLICABLE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: