Healthcare Provider Details

I. General information

NPI: 1659019461
Provider Name (Legal Business Name): CONCEIVE NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 STATE ROUTE 34 STE 4 BUILDING E, SUITE 4
WALL TOWNSHIP NJ
07727-2000
US

IV. Provider business mailing address

1599 STATE ROUTE 34 BUILDING E, SUITE 4
WALL TOWNSHIP NJ
07727-2000
US

V. Phone/Fax

Practice location:
  • Phone: 732-807-1613
  • Fax: 732-997-7613
Mailing address:
  • Phone: 732-807-1613
  • Fax: 732-997-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ISAAC Z GLATSTEIN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 732-807-7163