Individual
EDWARD H GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
80 MAPLE AVENUE, SMITHTOWN, NY 11787
(631) 265-5777
(631) 265-5797
Mailing address
80 MAPLE AVENUE, SMITHTOWN, NY 11787
(631) 265-5777
(631) 265-5797
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
094600
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00657167
—
NY
Enumeration date
08/12/2006
Last updated
08/24/2009
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