Provider Demographics
NPI:1487229068
Name:MOLYNEAUX, GLENN WEBSTER
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:WEBSTER
Last Name:MOLYNEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOLLISTER RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1139
Mailing Address - Country:US
Mailing Address - Phone:201-448-6895
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD UNIT 7
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1139
Practice Address - Country:US
Practice Address - Phone:201-448-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator