Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 010153-01 | NY |
NPI | 1033749452 |
---|---|
Provider Name | Jessica Glebus |
First Address | Lenox, MA 01240-2136 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2020 |
Last Update Date | 24/01/2020 |