Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 25MA05247500 | NJ |
NPI | 1225365612 |
---|---|
Provider Name | Dr. Glenn Joseph Gormley |
First Address | Brick, NJ 08724-4816 |
Second Address | Brick, NJ 08724-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 06/11/2009 |