Individual
GLEN ACO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1 PENN PLZ FL 8, NEW YORK, NY 10119-0899
(212) 216-6415
(844) 291-7539
Mailing address
1 PENN PLZ FL 8, NEW YORK, NY 10119-0899
(212) 216-6415
(844) 291-7539
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
504963-1
NY
Other
Enumeration date
11/22/2006
Last updated
01/20/2016
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