Provider Demographics
NPI:1376510792
Name:GLOTZER, TAYA VALERIE (MD)
Entity Type:Individual
Prefix:
First Name:TAYA
Middle Name:VALERIE
Last Name:GLOTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E HILL CT
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2701
Mailing Address - Country:US
Mailing Address - Phone:201-569-8652
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:STE 701
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-2997
Practice Address - Fax:201-996-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06231100207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3346858OtherAETNA HMO
NJ8213938OtherGHI PPO
NJ7804530OtherAETNA PPO#
NY02868871Medicaid
NJ8085501Medicaid
NJ3K6524OtherHEALTHNET
NJP2168582OtherOXFORD
NJ7804530OtherAETNA PPO#
NJ8213938OtherGHI PPO
NY641P4YBXT1Medicare PIN