Healthcare Provider Details

I. General information

NPI: 1346483815
Provider Name (Legal Business Name): NINA ELIZABETH GLASS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S ORANGE AVE MSB G526
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

90 BERGEN ST STE 7100
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6293
  • Fax: 973-972-6803
Mailing address:
  • Phone: 973-972-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA09883500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number25MA09883500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09883500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: