Basic Information
| Provider Information | |||||||||
| NPI: | 1710156500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLASS & INSERRA, M.D P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 MIDDLE COUNTRY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117872844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313602200 | ||||||||
| FaxNumber: | 6313601328 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 MIDDLE COUNTRY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117872844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313602200 | ||||||||
| FaxNumber: | 6313601328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2008 | ||||||||
| LastUpdateDate: | 09/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | GLASS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6313602200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 116939 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1710156500 | 05 | NY | MEDICAID | CF3379 | 01 | NY | RR MEDICARE | OTHER |