Provider Demographics
NPI:1598732935
Name:RADOSLOVICH, GLAUCO (MD)
Entity Type:Individual
Prefix:
First Name:GLAUCO
Middle Name:
Last Name:RADOSLOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINSTON DR
Mailing Address - Street 2:11CS
Mailing Address - City:CLIFFSIDE PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3240
Mailing Address - Country:US
Mailing Address - Phone:201-224-9845
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:STE 701
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-2997
Practice Address - Fax:201-996-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0575800207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2101549OtherGHI PPO
NJBS504OtherOXFORD
NJ81061OtherAMERIGROUP
NJ000000120940OtherGHI HMO
NY02868633Medicaid
NJ4545953OtherAETNA PPO
NJ2307025OtherAETNA HMO
NJ5387906Medicaid
NJBS504OtherOXFORD
NJ81061OtherAMERIGROUP
NJ5387906Medicaid