Provider Demographics
NPI:1346449881
Name:EDWARD GLAVEY, DO PC
Entity Type:Organization
Organization Name:EDWARD GLAVEY, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GLAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PC
Authorized Official - Phone:201-420-7903
Mailing Address - Street 1:330 GRAND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2728
Mailing Address - Country:US
Mailing Address - Phone:516-263-9374
Mailing Address - Fax:
Practice Address - Street 1:120 ALCOTT PL
Practice Address - Street 2:# 120J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4201
Practice Address - Country:US
Practice Address - Phone:516-263-9374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07615600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB07615600OtherLICENSE
NJ25MB07615600OtherLICENSE
NJBG8197003OtherDEA