Individual provider Active NPI

Glenn L Stoller, M.D.

  • Ophthalmology Physician
  • Rockville Centre, NY
National Provider Identifier
1558366526
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
186295 Issued in NY
Practice address
2000 N Village Ave
Ste 402
Rockville Centre, NY 11570-1001
Phone
(516) 766-2519
Fax
(516) 766-3714
NPI assigned
Jun 16, 2005
Last updated
Sep 17, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 186295 NY Primary

Addresses

Primary practice location

2000 N Village Ave
Ste 402
Rockville Centre, NY 11570-1001

Mailing address

825 E Gate Blvd Ste 111
Garden City, NY 11530-2136
Phone (516) 804-5200

Other identifiers 1

IdentifierTypeStateIssuer
01809778MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091202000378 NY Practitioner - Ophthalmology 1850430901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
New York University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2000 N Village Ave
Rockville Centre, NY 11570-1078
Phone (516) 766-2519

2000 N Village Ave
Suite 30
Rockville Centre, NY 11570-1001

2860 Long Beach Rd
Oceanside, NY 11572-3114
Phone (516) 593-7709

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
186295NYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ophthalmic Consultants of Long Island Ophthalmology CurrentSince Jul 10, 1997 Accepting new patients
Ophthalmic Consultants of Long Island Ophthalmology Past Accepting new patients

Locations

4 Technology Dr
Ste 150
East Setauket, NY 11733
Phone (631) 941-1400

825 E Gate Blvd
Ste 111
Garden City, NY 11530
Phone (516) 804-5200

2860 Long Beach Rd
Oceanside, NY 11572
Phone (516) 593-7709

2000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1777

2000 N Village Ave
#13202
Rockville Ctr, NY 11570
Phone (516) 766-2519

2000 N Village Ave
Ste 30
Rockville Ctr, NY 11570
Phone (516) 766-2519

2000 N Village Ave
Ste 402
Rockville Ctr, NY 11570
Phone (516) 766-2519

865 Merrick Ave
Ste 80N
Westbury, NY 11590
Phone (516) 804-5200

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: glenn.stoller.p1@direct.ocli.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1558366526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 E GATE BLVD STE 111",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115302136",
            "telephone_number": "516-804-5200",
            "fax_number": "516-240-6540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N VILLAGE AVE",
            "address_2": "STE 402",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701001",
            "telephone_number": "516-766-2519",
            "fax_number": "516-766-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLLER",
        "first_name": "GLENN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "186295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01809778",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.