Healthcare Provider Details

I. General information

NPI: 1184985095
Provider Name (Legal Business Name): EVAN MICHAEL GLEIMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901
US

IV. Provider business mailing address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2000
  • Fax:
Mailing address:
  • Phone: 908-522-2000
  • Fax: 856-566-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB09956300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: