Healthcare Provider Details

I. General information

NPI: 1467165720
Provider Name (Legal Business Name): SHAYNA GLASSBERG SERGEV DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAYNA GLASSBERG SERGEV DO

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RWJ PLACE
NEW BRUNSWICK NJ
08901-1382
US

IV. Provider business mailing address

2001 RIVIERA DR UNIT 103
MOUNT PLEASANT SC
29464-7588
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3000
  • Fax:
Mailing address:
  • Phone: 609-437-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97308
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: