Healthcare Provider Details

I. General information

NPI: 1568682458
Provider Name (Legal Business Name): ALLEN S. GLUSHAKOW, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ELMORA AVE
ELIZABETH NJ
07202-1169
US

IV. Provider business mailing address

22 OLD SHORT HILLS RD SUITE 210
LIVINGSTON NJ
07039-5604
US

V. Phone/Fax

Practice location:
  • Phone: 908-629-9000
  • Fax: 908-629-9030
Mailing address:
  • Phone: 973-533-1070
  • Fax: 973-533-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA27130NJ
License Number StateNJ

VIII. Authorized Official

Name: DR. ALLEN S. GLUSHAKOW
Title or Position: OWNER
Credential: M.D.
Phone: 973-533-1070