Healthcare Provider Details

I. General information

NPI: 1356756613
Provider Name (Legal Business Name): MARJORIE ANNE GLASSER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS HWY S SUITE 2500
ROCHESTER NY
14617-5504
US

IV. Provider business mailing address

100 KINGS HWY S SUITE 2500
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-1545
  • Fax: 585-922-1524
Mailing address:
  • Phone: 585-922-1545
  • Fax: 585-922-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number590756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: