Healthcare Provider Details

I. General information

NPI: 1659599918
Provider Name (Legal Business Name): STEVEN JEROMEG GLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WHITE HORSE PIKE
CLEMENTON NJ
08021-4159
US

IV. Provider business mailing address

93 REMSTERVILLE RD
ELMER NJ
08318-2940
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-9000
  • Fax: 856-566-9701
Mailing address:
  • Phone: 856-358-8419
  • Fax: 856-358-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA 44289
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: