MEDICARE: JONATHAN MICHAEL GLOTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25 MA08818800	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190089SDI	OTHER	NJ	MEDICARE IDENTIFIER

General Provider Information

NPI Number	:	1932361110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MICHAEL GLOTH M.D.

Provider Business Mailing Address
First Line	:	780 RT. 37 WEST
Second Line	:	SUITE 200
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1856
Country	:	US
Telephone Number	:	732-797-1855
Fax Number	:	732-797-1856

Provider Business Practice Location Address
First Line	:	780 RT 37 WEST
Second Line	:	SUITE 200
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1856
Country	:	US
Telephone Number	:	732-797-1855
Fax Number	:	732-797-1856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	05/12/2015

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