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General NPI Number Information
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NPI Number | 1356454540
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Entity Type | Individual
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Provider Name | CRAIG STEVEN GLICK MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 65 W JIMMIE LEEDS RD
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City | POMONA
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State | NJ
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Zip | 08240-9102
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Country | US
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Telephone | 609-677-9729
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Fax | 609-652-6270
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Provider Business Mailing Address
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Address Line | 72 W JIMMIE LEEDS RD SUITE 1100
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City | GALLOWAY
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State | NJ
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Zip | 08205-9406
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Country | US
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Telephone | 609-677-9729
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Fax | 609-652-7153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 25MA05779700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA05779700
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License Number State | NJ
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