Provider Demographics
NPI:1235264854
Name:ZWERIN, GLENN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALAN
Last Name:ZWERIN
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 1:133 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6415
Mailing Address - Country:US
Mailing Address - Phone:732-222-7650
Mailing Address - Fax:732-222-7850
Practice Address - Street 1:133 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6415
Practice Address - Country:US
Practice Address - Phone:732-222-7650
Practice Address - Fax:732-222-7850
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO5911300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21224Medicare UPIN
ZW460446Medicare ID - Type Unspecified