Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 25ME00067100 | NJ |
NPI | 1063982429 |
---|---|
Provider Name | Mrs. Sheva Gluck |
First Address | Lakewood, NJ 08701 |
Second Address | Lakewood, NJ 08701-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 28/11/2018 |