Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 113037 | NY |
Y | 208600000X | Surgeon | 113037 | NY |
NPI | 1013991645 |
---|---|
Provider Name | Dr. Burton Joel Glass |
First Address | Plainview, NY 11803-4914 |
Second Address | Plainview, NY 11803-4914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00416931 | (05) | NY |
C05102 | (02) |