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General NPI Number Information
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NPI Number | 1619871621
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Entity Type | Individual
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Provider Name | DR. JONATHAN R GLAZER
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Gender | Male
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 451 CLARKSON AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2054
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Country | US
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Telephone | 718-245-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 65 WOODLAWN AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1534
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Country | US
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Telephone | 917-662-6199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NULL
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