1932901071 NPI number — SNF PHYSIATRY SERVICES PA PLLC

Table of content: MS. JACQUELINE N. GLICK LCSW (NPI 1891919833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932901071 NPI number — SNF PHYSIATRY SERVICES PA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNF PHYSIATRY SERVICES PA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1932901071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 ROUTE 70 STE 305
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:
08755-0911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 S BROAD ST FL 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19109-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-813-0799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2025

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-813-0799

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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