Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25 MA02198400 | NJ |
NPI | 1124195375 |
---|---|
Provider Name | Alvin I. Glasgold |
First Address | Highland Park, NJ 08904-1731 |
Second Address | Highland Park, NJ 08904-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG95279 | (02) | NJ |