Healthcare Provider Details

I. General information

NPI: 1548007735
Provider Name (Legal Business Name): E GLANTZ DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 VERMONT AVE
LAKEWOOD NJ
08701-6145
US

IV. Provider business mailing address

860 VERMONT AVE
LAKEWOOD NJ
08701-6145
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-8474
  • Fax: 732-722-1024
Mailing address:
  • Phone: 845-494-8474
  • Fax: 732-722-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC J GLANTZ
Title or Position: OWNER
Credential: DO
Phone: 845-494-8474