Healthcare Provider Details

I. General information

NPI: 1386831337
Provider Name (Legal Business Name): SVETLANA GLADOUN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/09/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ROUTE 23 STE 350
WAYNE NJ
07470-7538
US

IV. Provider business mailing address

1839 E 13TH ST
BROOKLYN NY
11229-2807
US

V. Phone/Fax

Practice location:
  • Phone: 973-521-9700
  • Fax:
Mailing address:
  • Phone: 718-891-1551
  • Fax: 718-891-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number258075
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB1052050
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier258075
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: