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General NPI Number Information
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NPI Number | 1063644714
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Entity Type | Organization
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Legal Business Name | GREAT MEDICAL SERVICES P.C.
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1 MAIDEN LN FL 4
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City | NEW YORK
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State | NY
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Zip | 10038-5130
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Country | US
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Telephone | 212-791-3399
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Fax | 212-791-3388
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Provider Business Mailing Address
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Address Line | 1 MAIDEN LN FL 4
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City | NEW YORK
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State | NY
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Zip | 10038-5130
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Country | US
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Telephone | 212-791-3399
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Fax | 212-791-3388
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Authorized Official
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Title or Position | OWNER
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Name | DAVID M. GLASS
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Credential | M.D.
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Telephone | 212-791-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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