Healthcare Provider Details

I. General information

NPI: 1013952399
Provider Name (Legal Business Name): GAIL A GLOECKLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VALLEY BROOK AVE
LYNDHURST NJ
07071-1930
US

IV. Provider business mailing address

209 UNION ST UNIT #6
LODI NJ
07644-3263
US

V. Phone/Fax

Practice location:
  • Phone: 201-935-3322
  • Fax: 201-935-9196
Mailing address:
  • Phone: 973-777-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number26NO05042300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: