Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MA069963 | NJ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 25MA06996300 | NJ |
NPI | 1346227428 |
---|---|
Provider Name | Dr. Glenn G Gabisan |
First Address | Tinton Falls, NJ 07724-3006 |
Second Address | Tinton Falls, NJ 07724-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 04/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0047635 | (05) | NJ |
3222403 | (05) | NJ |
7679694 | AETNA ID# (01) | NJ |
CC3884 | RR MEDICARE GRP# (01) | NJ |
I16616 | (02) | NJ |
J34051 | HEALTHNET ID# (01) | NJ |
P00163993 | RR MEDICARE (01) | NJ |
P3362517 | OXFORD ID# (01) | NJ |