Active NPI
Robert J. Glanz, PA-C
- Physician Assistant
- Oswego, NY
National Provider Identifier
1407033459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1400
- Practice address
- 110 W 6TH St
Oswego, NY 13126-2507 - Phone
- (315) 349-5511
- NPI assigned
- Jan 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 012420 | NY | |
| Physician Assistant | 363A00000X | 1400 | MA | Primary |
Addresses
Primary practice location
110 W 6TH St
Oswego, NY 13126-2507
Mailing address
110 W 6TH St
Oswego, NY 13126-2507
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407033459 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1400 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294272000000",
"number": "1407033459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 W 6TH ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 W 6TH ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262507",
"telephone_number": "315-349-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLANZ",
"first_name": "ROBERT",
"middle_name": "J.",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-22",
"last_updated": "2011-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "012420",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "1400",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1407033459",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.