Justin Ryan Glazer, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

053413 Issued in NY

Practice address

930 N Broadway
Massapequa, NY 11758-2394

Phone

(516) 541-2400

Fax

(516) 308-3812

NPI assigned

Sep 10, 2008

Last updated

Apr 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

Ohio State University College of Dentistry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Siegel Cerbone and Mazzei LLPGroup PAC ID 3375690779, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Long Island Oral Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Massapequa, NY
  • NPI 1811141492
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1912156241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582394",
            "telephone_number": "516-541-2400",
            "fax_number": "516-308-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582394",
            "telephone_number": "516-541-2400",
            "fax_number": "516-308-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLAZER",
        "first_name": "JUSTIN",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-10",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "053413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Michael Giuliani, DDS
• Christine Giurcanu, LMSW
• Noam Glaser, M.D.
• Kenneth Joel Glassberg, DDS
• Phillip Glassberg, D.D.S.
• Denise Glenn, LCSW
• Cari Michele Glenz, OTR/L
• Goldberg and Defeo DDS PLLC
• Joan B Goldberg, PHD
• Anita Goldman, N.P.

• Oral and Maxillofacial Surgery (Dentist) in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.