Basic Information
| Provider Information | |||||||||
| NPI: | 1104801174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLASSMAN | ||||||||
| FirstName: | BEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 SAW MILL RIVER RD | ||||||||
| Address2: | 2ND. FLOOR | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105321533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145931659 | ||||||||
| FaxNumber: | 9145931790 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 BRADHURST AVE | ||||||||
| Address2: | SUITE 2400 | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145938850 | ||||||||
| FaxNumber: | 9145943747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 128561 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 018597 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000092201 | 01 | NY | GHI HMO | OTHER | 0562451 | 01 | NY | AETNA(HMO) PRIMARY CARE | OTHER | 662Z61 | 01 | NY | BLUE CROSS PPO | OTHER | 133884168 | 01 | NY | POMCO | OTHER | 128561-8W | 01 | NY | WORKERS COMPENSATION | OTHER | 128561 | 01 | NY | CONNECTICARE | OTHER | 133884168 | 01 | NY | HORIZON HEALTHCARE OF NY | OTHER | 662Z61 | 01 | NY | SWSCHP | OTHER | 133884168 | 01 | NY | PHCS | OTHER | 2695454 | 01 | NY | GHI PPO | OTHER | 662Z61 | 01 | NY | EMPIRE BLUE CROSS HMO | OTHER | WP187 | 01 | NY | OXFORD | OTHER | 4237422 | 01 | NY | AETNA (NON HMO) | OTHER |