Healthcare Provider Details

I. General information

NPI: 1487012415
Provider Name (Legal Business Name): GLENN KNOBELMAN, D.C.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 LANDING RD
LANDING NJ
07850-1500
US

IV. Provider business mailing address

172 LANDING RD
LANDING NJ
07850-1500
US

V. Phone/Fax

Practice location:
  • Phone: 973-398-9330
  • Fax: 973-398-4552
Mailing address:
  • Phone: 973-398-9330
  • Fax: 973-398-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number38MC00154600
License Number StateNJ

VIII. Authorized Official

Name: DR. GLENN KNOBELMAN
Title or Position: OWNER
Credential: D.C.
Phone: 973-398-9330