Provider Demographics
NPI:1083663926
Name:PRETTITORE, GLENN DAVID (MSPT)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:DAVID
Last Name:PRETTITORE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ROCK RD
Mailing Address - Street 2:#236
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1708
Mailing Address - Country:US
Mailing Address - Phone:201-345-7044
Mailing Address - Fax:201-345-7062
Practice Address - Street 1:233 ROCK RD
Practice Address - Street 2:#236
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1708
Practice Address - Country:US
Practice Address - Phone:201-345-7044
Practice Address - Fax:201-345-7062
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009898002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058169OtherMEDCARE PROVIDER NUMBER