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General NPI Number Information
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NPI Number | 1467988774
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Entity Type | Organization
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Legal Business Name | GLASS PODIATRIC FOOT OBS, PC
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 315 MADISON AVE SUITE 2301
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City | NEW YORK
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State | NY
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Zip | 10017-5405
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Country | US
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Telephone | 212-867-2500
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Fax | 212-867-3845
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Provider Business Mailing Address
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Address Line | 315 MADISON AVE SUITE 2301
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City | NEW YORK
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State | NY
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Zip | 10017-5405
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Country | US
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Telephone | 212-867-2500
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Fax | 212-867-3845
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANDREW GLASS
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Credential | DPM
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Telephone | 212-867-2500
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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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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N006132
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License Number State | NY
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