Provider Demographics
NPI:1487012415
Name:GLENN KNOBELMAN, D.C.LLC
Entity Type:Organization
Organization Name:GLENN KNOBELMAN, D.C.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-398-9330
Mailing Address - Street 1:172 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1500
Mailing Address - Country:US
Mailing Address - Phone:973-398-9330
Mailing Address - Fax:973-398-4552
Practice Address - Street 1:172 LANDING RD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1500
Practice Address - Country:US
Practice Address - Phone:973-398-9330
Practice Address - Fax:973-398-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00154600261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451519Medicare PIN