Healthcare Provider Details

I. General information

NPI: 1437143047
Provider Name (Legal Business Name): GLEN JOSHPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28652 STATE HIGHWAY 23
STAMFORD NY
12167-1712
US

IV. Provider business mailing address

PO BOX 57
STAMFORD NY
12167-0057
US

V. Phone/Fax

Practice location:
  • Phone: 607-434-1300
  • Fax:
Mailing address:
  • Phone: 607-434-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number106381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: