MEDICARE: JORDAN B. GLASER M.D.P.C

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	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700931359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN B. GLASER M.D.P.C

Provider Business Mailing Address
First Line	:	1408 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2312
Country	:	US
Telephone Number	:	718-816-3362
Fax Number	:	718-979-4650

Provider Business Practice Location Address
First Line	:	1408 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2312
Country	:	US
Telephone Number	:	718-816-3362
Fax Number	:	718-979-4650

Authorized Official
Title or Position	:	INFECTIOUS DISEASE SPECIALIST
Name	:	JORDAN BARRY GLASER
Credential	:	M.D.P.C.
Telephone Number	:	718-816-3362

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	06/05/2020

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