Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X005691 | NY |
NPI | 1003845454 |
---|---|
Provider Name | Dr. Bonnie S. Glassman |
First Address | Forest Hills, NY 11375-0426 |
Second Address | Forest Hills, NY 11375-5513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BG0X411110 | BLUE CROSS (01) | NY |
PI962246 | OXFORD (01) | NY |
U02980 | (02) | NY |
X005691 | STATE LICENSE (01) | NY |