Healthcare Provider Details

I. General information

NPI: 1659323699
Provider Name (Legal Business Name): HARRY GLASS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 OCEAN RD STE 510
OCEAN CITY NJ
08226-4548
US

IV. Provider business mailing address

207 OCEAN RD
OCEAN CITY NJ
08226-4548
US

V. Phone/Fax

Practice location:
  • Phone: 609-706-1935
  • Fax: 609-710-0501
Mailing address:
  • Phone: 609-706-1935
  • Fax: 609-710-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number25MB02315400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS-002704L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: