Provider Demographics
NPI:1568552966
Name:ZUCK, GLENN M (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:M
Last Name:ZUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 NEW RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2038
Mailing Address - Country:US
Mailing Address - Phone:609-927-9200
Mailing Address - Fax:609-927-1616
Practice Address - Street 1:547 NEW RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2038
Practice Address - Country:US
Practice Address - Phone:609-927-9200
Practice Address - Fax:609-927-1616
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB0484720207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6327907Medicaid
NJ6327907Medicaid
NJ720216CNNMedicare PIN