Healthcare Provider Details

I. General information

NPI: 1598732935
Provider Name (Legal Business Name): GLAUCO RADOSLOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 701
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

100 WINSTON DR 11CS
CLIFFSIDE PK NJ
07010-3240
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2997
  • Fax: 201-996-2571
Mailing address:
  • Phone: 201-224-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA0575800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2101549
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI PPO
# 2
IdentifierBS504
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD
# 3
Identifier81061
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERIGROUP
# 4
Identifier000000120940
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI HMO
# 5
Identifier02868633
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 6
Identifier4545953
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO
# 7
Identifier2307025
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA HMO
# 8
Identifier5387906
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: