Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | G61252 | CA |
N | 207NS0135X | Procedural Dermatology | G61252 | CA |
NPI | 1154387413 |
---|---|
Provider Name | Mr. Edward Glassberg |
First Address | Long Beach, CA 90808-1793 |
Second Address | Long Beach, CA 90808-1793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 02/11/2020 |