Provider Demographics
NPI:1275530404
Name:SILBERT, GLENN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:RICHARD
Last Name:SILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 HARRISTOWN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3317
Mailing Address - Country:US
Mailing Address - Phone:201-797-5100
Mailing Address - Fax:201-797-4160
Practice Address - Street 1:316 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5529
Practice Address - Country:US
Practice Address - Phone:201-342-8115
Practice Address - Fax:201-342-3257
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04220700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSI112096Medicare PIN
NJB20614Medicare UPIN