Provider Demographics
NPI:1063573442
Name:GLICKMAN, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORTH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2114
Mailing Address - Country:US
Mailing Address - Phone:908-276-0200
Mailing Address - Fax:908-276-0200
Practice Address - Street 1:23 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2114
Practice Address - Country:US
Practice Address - Phone:908-276-0200
Practice Address - Fax:908-276-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311091OtherNVA
NJ0032534OtherUNITED HEALTHCARE
NJ6500089OtherGHI
NJ6500089OtherGHI