Active NPI
Kenneth I Glassberg, MD
- Specialist
- New York, NY
National Provider Identifier
1780738898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 110936
- Practice address
- 3959 Broadway
11TH Floor
New York, NY 10032-1559 - Phone
- (212) 305-9918
- NPI assigned
- Jan 23, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 110936 | NY | Primary |
Addresses
Primary practice location
3959 Broadway
11TH Floor
New York, NY 10032-1559
Mailing address
3959 Broadway
11TH Floor
New York, NY 10032-1559
Phone (212) 305-9918
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110936 | Other | NY | HIP |
| 69990 | Other | NY | UNHC |
| HEALTHNET | Other | NY | HEALTHNET |
| 0604219 | Other | NY | CIGNA |
| 4250348 | Other | NY | AETNA PPO |
| KS573 | Other | NY | OXFORD |
| 668248 | Other | NY | AETNA |
| 0043642 | Other | NY | GHI |
| 00198536 | Medicaid | NY | |
| 20631247 | Other | NY | BEECHSTREET |
| 3S8981 | Other | NY | EBCBS |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110936 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780738898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3959 BROADWAY",
"address_2": "11TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100321559",
"telephone_number": "212-305-9918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3959 BROADWAY",
"address_2": "11TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100321559",
"telephone_number": "212-305-9918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASSBERG",
"first_name": "KENNETH",
"middle_name": "I",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "110936",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "110936",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNHC",
"identifier": "69990",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "HEALTHNET",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0604219",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "4250348",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "KS573",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "668248",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0043642",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00198536",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECHSTREET",
"identifier": "20631247",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EBCBS",
"identifier": "3S8981",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.