Healthcare Provider Details

I. General information

NPI: 1558590299
Provider Name (Legal Business Name): GLENN MICHAEL AUFSEESER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MADISON AVE
LAKEWOOD NJ
08701-1253
US

IV. Provider business mailing address

1700 MADISON AVE
LAKEWOOD NJ
08701-1253
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-5151
  • Fax:
Mailing address:
  • Phone: 732-367-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006104
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00332400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC006104
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberSC006104
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC006104
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC006104
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006104
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: