Healthcare Provider Details

I. General information

NPI: 1568552966
Provider Name (Legal Business Name): GLENN M ZUCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 NEW RD
SOMERS POINT NJ
08244-2038
US

IV. Provider business mailing address

547 NEW RD
SOMERS POINT NJ
08244-2038
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-9200
  • Fax: 609-927-1616
Mailing address:
  • Phone: 609-927-9200
  • Fax: 609-927-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMB0484720
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: