1659323699 NPI number — HARRY GLASS DO

Table of content: HARRY GLASS DO (NPI 1659323699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659323699 NPI number — HARRY GLASS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASS
Provider First Name:
HARRY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1659323699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 OCEAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08226-4548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-706-1935
Provider Business Mailing Address Fax Number:
609-710-9591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 OCEAN RD STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08226-4548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-706-1935
Provider Business Practice Location Address Fax Number:
609-710-0501
Provider Enumeration Date:
05/17/2006

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: 207LP2900X , with the licence number:  OS-002704L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LA0401X , with the licence number: 25MB02315400 , 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: 0022342000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "HORIZON BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33028C . This is a "HORIZON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8194307 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1169961 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33029C . This is a "HORIZON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50085446 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000640054 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-1994560 . This is a "HORIZON BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "PROCURA MANAGEMENT, INC." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "UNITED HEALTHCARE/OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "FIRST MCO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1201409 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659323699 . This is a "BRAVO HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "FIRST MCO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com