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General NPI Number Information
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NPI Number | 1710156500
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Entity Type | Organization
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Legal Business Name | GLASS & INSERRA, M.D P.C.
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 309 MIDDLE COUNTRY RD SUITE 101
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City | SMITHTOWN
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State | NY
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Zip | 11787-2844
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Country | US
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Telephone | 631-360-2200
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Fax | 631-360-1328
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Provider Business Mailing Address
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Address Line | 309 MIDDLE COUNTRY RD SUITE 101
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City | SMITHTOWN
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State | NY
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Zip | 11787-2844
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Country | US
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Telephone | 631-360-2200
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Fax | 631-360-1328
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH S GLASS
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Credential | M.D.
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Telephone | 631-360-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 116939
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License Number State | NY
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