Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 060149-01 | NY |
NPI | 1003342593 |
---|---|
Provider Name | Dr. Johanna M Glasner |
First Address | New York, NY 10024-1715 |
Second Address | New York, NY 10025-6468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2017 |
Last Update Date | 06/01/2022 |