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General NPI Number Information
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NPI Number | 1962197442
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Entity Type | Individual
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Provider Name | KADEEM IMAN GLASGOW PA
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Gender | Male
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 1250 WATERS PL
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 800-636-6683
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Fax |
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Provider Business Mailing Address
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Address Line | 22115 HEMPSTEAD AVE APT 2D
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2106
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Country | US
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Telephone | 347-451-9202
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 029847
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 029847
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License Number State | NY
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