Provider Demographics
NPI:1316930936
Name:GLASSMAN, RONALD MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:MICHAEL
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CEDAR LN
Mailing Address - Street 2:L-4
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4316
Mailing Address - Country:US
Mailing Address - Phone:201-836-0888
Mailing Address - Fax:201-836-6662
Practice Address - Street 1:185 CEDAR LN
Practice Address - Street 2:L-4
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4316
Practice Address - Country:US
Practice Address - Phone:201-836-0888
Practice Address - Fax:201-836-6662
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04841000207W00000X
NY1589551207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1650203Medicaid
NJGL453396Medicare ID - Type Unspecified
NJ1650203Medicaid