Provider Demographics
NPI:1376731182
Name:FLOREK, WALTER GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:GLENN
Last Name:FLOREK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 70
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5847
Mailing Address - Country:US
Mailing Address - Phone:732-364-0040
Mailing Address - Fax:732-364-0171
Practice Address - Street 1:525 ROUTE 70
Practice Address - Street 2:SUITE A-3
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5847
Practice Address - Country:US
Practice Address - Phone:732-364-0040
Practice Address - Fax:732-364-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00224300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0912994OtherSOURCE IDENTIFICATION NUM
NJ0912994OtherSOURCE IDENTIFICATION NUM