1801847629 NPI number — ALEXANDER B GLICKMAN M.D.

Table of content: ALEXANDER B GLICKMAN M.D. (NPI 1801847629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801847629 NPI number — ALEXANDER B GLICKMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLICKMAN
Provider First Name:
ALEXANDER
Provider Middle Name:
B
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:
1801847629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-349-3838
Provider Business Mailing Address Fax Number:
732-349-2233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 PASSAIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-779-7999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2006

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: 207Y00000X , with the licence number:  25MA06345200 , 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: 0699977 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6945805 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01000449006 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83783 . This is a "AMGP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1281074 . This is a "OX" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00165380 . This is a "RRM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1821709 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K7355 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30148 . This is a "UHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0993219000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1144690 . This is a "MHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3544558 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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