Edward H Glenn, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

094600 Issued in NY

Practice address

80 Maple Avenue
Smithtown, NY 11787

Phone

(631) 265-5777

Fax

(631) 265-5797

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Port Interventional Radiology PC

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  • Port Jefferson, NY
  • NPI 1164434924
  NPD (past) Authorized official
• Port Radiation Therapy PC

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1356412035
  NPD (past) Authorized official
• Professional Radiology PC

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1619989464
  NPD (past) Authorized official
• Radiologic Health Services MRI of Smithtown PC

  • Diagnostic Radiology Physician
  • Smithtown, NY
  • NPI 1619908100
  NPD (past) Authorized official
• Radiology Health Services, PC

  • Diagnostic Radiology Physician
  • Smithtown, NY
  • NPI 1558386219
  NPD (past) Authorized official

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251072000000",
    "number": "1922010776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MAPLE AVENUE",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-265-5777",
            "fax_number": "631-265-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAPLE AVENUE",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-265-5777",
            "fax_number": "631-265-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "EDWARD",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2009-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "094600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00657167",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodi Glasser, LCSW
• Sheri Beth Glazer, D.D.S.
• Carrie-Anne Gleason
• Francis Xavier Gleason, M.D.
• Michaela Gleason
• Glucose Guards LLC
• Brian S. Gobbi, OTR
• Sharon Gobbi
• Stephenie Gobris
• Katie Anne Goehle, LMSW

• Diagnostic Radiology Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.