MEDICARE: SIDNEY S. GLASBERG M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	091795	NY

General Provider Information

NPI Number	:	1679641328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY S. GLASBERG M.D.

Provider Business Mailing Address
First Line	:	1751 BARD LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-1503
Country	:	US
Telephone Number	:	516-794-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 HUNTER ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4212
Country	:	US
Telephone Number	:	718-269-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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