Provider Demographics
NPI:1215952841
Name:GLICK, EILEEN S (CRNA)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:S
Last Name:GLICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-0606
Mailing Address - Country:US
Mailing Address - Phone:215-785-0145
Mailing Address - Fax:215-785-0161
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:SUITE 510
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2624
Practice Address - Country:US
Practice Address - Phone:215-785-0145
Practice Address - Fax:215-785-0161
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN189785L163W00000X, 367500000X
NJ26NJ00195700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076960RVBOtherNATIONAL GOVERNMENT SERVICES (NJ EMPIRE)
PA430033948OtherRAILROAD MEDICARE
NJ145020RVBMedicare PIN
PA007200GDNMedicare PIN
NJ076960RVBOtherNATIONAL GOVERNMENT SERVICES (NJ EMPIRE)