Provider Demographics
NPI:1962621938
Name:ALLEN S. GLUSHAKOW,M.D.,P.A.
Entity type:Organization
Organization Name:ALLEN S. GLUSHAKOW,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLUSHAKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-533-1070
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-533-1010
Mailing Address - Fax:973-533-7990
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-533-1010
Practice Address - Fax:973-533-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27130NJ207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56171Medicare UPIN
NJ0906230001Medicare NSC
NJ459933Medicare ID - Type Unspecified