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General NPI Number Information
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NPI Number | 1679552103
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Entity Type | Individual
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Provider Name | LAURIE GLASSER MD
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Gender | Female
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2315 ROUTE 34
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City | MANASQUAN
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State | NJ
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Zip | 08736-1444
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Country | US
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Telephone | 732-974-0404
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Fax | 732-449-4271
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Provider Business Mailing Address
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Address Line | 2315 ROUTE 34
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City | MANASQUAN
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State | NJ
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Zip | 08736-1444
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Country | US
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Telephone | 732-974-0404
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Fax | 732-449-4271
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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 | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number | 25MA05957600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA05957600
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License Number State | NJ
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