Provider Demographics
NPI:1730241704
Name:GLASS, DEBBIE (MD)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 AMITY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6004
Mailing Address - Country:US
Mailing Address - Phone:929-455-2500
Mailing Address - Fax:
Practice Address - Street 1:97 AMITY ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:929-455-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
113655027OtherPHCS PROVIDER ID #
180061302OtherUNITED HEALTHCARE PROV ID
4301733005OtherCIGNA HEALTHCARE PROV ID
P726043OtherOXFORD FREEDOM PROVIDER #
4301733005OtherCIGNA HEALTHCARE PROV ID