Provider Demographics
NPI:1124195375
Name:GLASGOLD, ALVIN I (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:I
Last Name:GLASGOLD
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 1:31 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1731
Mailing Address - Country:US
Mailing Address - Phone:732-846-6540
Mailing Address - Fax:732-846-8231
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1731
Practice Address - Country:US
Practice Address - Phone:732-846-6540
Practice Address - Fax:732-846-8231
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA02198400207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAG95279Medicare UPIN
022908Medicare PIN