Provider Demographics
NPI:1528206695
Name:ERIC D. GLASOFER MD PA
Entity Type:Organization
Organization Name:ERIC D. GLASOFER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-772-1200
Mailing Address - Street 1:1000 WHITE HORSE RD STE 904
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4415
Mailing Address - Country:US
Mailing Address - Phone:856-772-1200
Mailing Address - Fax:856-772-9674
Practice Address - Street 1:1000 WHITE HORSE RD STE 904
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4415
Practice Address - Country:US
Practice Address - Phone:856-772-1200
Practice Address - Fax:856-772-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04097700261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084715OtherMEDICARE IDENTIFICATION NUMBER
NJ084715Medicare UPIN