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NPI Code Detail

MEDICARE: NICOLE GLYNN M.D.

MEDICARE: NICOLE GLYNN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician25MA07698700NJ

General Provider Information

NPI Number : 1235134479
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GLYNN M.D.
Provider Business Mailing Address
First Line : 579A CRANBURY RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-5426
Country : US
Telephone Number : 732-390-0040
Fax Number : 732-390-1856
Provider Business Practice Location Address
First Line : 579A CRANBURY RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-5426
Country : US
Telephone Number : 732-390-0040
Fax Number : 732-390-1856
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 11/25/2014

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