MEDICARE: NOAM GLASER, M.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174400000X	Specialist
2	207ND0101X	MOHS-Micrographic Surgery Physician
3	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1013121656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAM GLASER, M.D. PC

Provider Business Mailing Address
First Line	:	727 N BROADWAY
Second Line	:	SUITE C2
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-799-0210
Fax Number	:	516-799-0247

Provider Business Practice Location Address
First Line	:	727 N BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-799-0210
Fax Number	:	516-799-0247

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NOAM GLASER
Credential	:	M.D.
Telephone Number	:	516-799-0210

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/21/2020

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