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General NPI Number Information
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NPI Number | 1760798086
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Entity Type | Organization
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Legal Business Name | BURTON J GLASS MD PC
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 24 MAPLE AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4259
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Country | US
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Telephone | 516-536-3737
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Fax | 516-536-3676
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Provider Business Mailing Address
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Address Line | 24 MAPLE AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4259
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Country | US
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Telephone | 516-536-3737
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Fax | 516-536-3676
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Authorized Official
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Title or Position | MD
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Name | DR. BURTON GLASS
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Credential |
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Telephone | 515-536-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 113037-1
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License Number State | NY
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