=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104801174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEN A GLASSMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 BRADHURST AVE SUITE 2400
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10532-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-593-8850
-----------------------------------------------------
Fax | 914-594-3747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 SAW MILL RIVER RD 2ND. FLOOR
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10532-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-593-1659
-----------------------------------------------------
Fax | 914-593-1790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 128561
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 018597
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------