Provider Demographics
NPI:1003879271
Name:GLUSHANOK, EUGENIA (PA)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:GLUSHANOK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:721-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:94 OLD SHORT HILLS ROAD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5606
Practice Address - Country:US
Practice Address - Phone:201-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00042900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094411TS6Medicare PIN
NJQ51657Medicare UPIN
NJ094411Medicare ID - Type Unspecified