Provider Demographics
NPI:1609868728
Name:BLUSTEIN, GLEN H (OD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:H
Last Name:BLUSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROCKLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2212
Mailing Address - Country:US
Mailing Address - Phone:201-684-9000
Mailing Address - Fax:201-684-9002
Practice Address - Street 1:125 ROCKLAND PLZ
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2212
Practice Address - Country:US
Practice Address - Phone:201-684-9000
Practice Address - Fax:201-684-9002
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 05364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2016849000OtherVSP
NJ2568836OtherAETNA
NJ2016849000OtherVSP
NJ2568836OtherAETNA