Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 035864 | NY |
NPI | 1003018466 |
---|---|
Provider Name | Glen J. Applebaum |
First Address | Harrison, NY 10528-1806 |
Second Address | New Rochelle, NY 10804-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |