Provider Demographics
NPI:1063400877
Name:GLYSING-JENSEN, TROELS (DPM)
Entity type:Individual
Prefix:DR
First Name:TROELS
Middle Name:
Last Name:GLYSING-JENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 N ABERDEEN AVE
Mailing Address - Street 2:LIFECARE PODIATRY
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3537
Mailing Address - Country:US
Mailing Address - Phone:610-293-9383
Mailing Address - Fax:610-293-0409
Practice Address - Street 1:237 N ABERDEEN AVE
Practice Address - Street 2:LIFECARE PODIATRY
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3537
Practice Address - Country:US
Practice Address - Phone:610-293-9383
Practice Address - Fax:610-293-0409
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000169213E00000X
PASC005575L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011912040001Medicaid
DE1000035515Medicaid
DEE1-0000169OtherLICENSE
PASC005575LOtherLICENSE
DEE1-0000169OtherLICENSE
DE014760L38Medicare PIN
PA075959HCGMedicare PIN