Provider Demographics
NPI:1386882207
Name:DAEHNKE, GLENN H (CPED)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:H
Last Name:DAEHNKE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175-15 SHARPS RUN PLAZA
Mailing Address - Street 2:RT. 70
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-953-0909
Mailing Address - Fax:609-953-0909
Practice Address - Street 1:175 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2300
Practice Address - Country:US
Practice Address - Phone:609-953-0909
Practice Address - Fax:609-953-0909
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter