Healthcare Provider Details

I. General information

NPI: 1013729631
Provider Name (Legal Business Name): BARI GLASSMAN RD, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-41 NEWARK ST FL 5
HOBOKEN NJ
07030-5627
US

IV. Provider business mailing address

281 W LINCOLN HWY UNIT 404
EXTON PA
19341-2663
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-1665
  • Fax:
Mailing address:
  • Phone: 215-880-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX7039
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: