1598732935 NPI number — GLAUCO RADOSLOVICH M.D.

Table of content: GLAUCO RADOSLOVICH M.D. (NPI 1598732935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598732935 NPI number — GLAUCO RADOSLOVICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADOSLOVICH
Provider First Name:
GLAUCO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598732935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WINSTON DR
Provider Second Line Business Mailing Address:
11CS
Provider Business Mailing Address City Name:
CLIFFSIDE PK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010-3240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-224-9845
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PROSPECT AVE
Provider Second Line Business Practice Location Address:
STE 701
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-996-2997
Provider Business Practice Location Address Fax Number:
201-996-2571
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  25MA0575800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2101549 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BS504 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 81061 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000000120940 . This is a "GHI HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 02868633 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4545953 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2307025 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5387906 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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