Healthcare Provider Details

I. General information

NPI: 1063982429
Provider Name (Legal Business Name): SHEVA GLUCK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 LANES MILL RD STE 201
LAKEWOOD NJ
08701-3894
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-4242
  • Fax: 732-363-5164
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17868900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00067100
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00067101
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: