Provider Demographics
NPI: | 1659323699 |
---|---|
Name: | GLASS, HARRY (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | HARRY |
Middle Name: | |
Last Name: | GLASS |
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: | 207 OCEAN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | OCEAN CITY |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08226-4548 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-706-1935 |
Mailing Address - Fax: | 609-710-9591 |
Practice Address - Street 1: | 207 OCEAN RD STE 510 |
Practice Address - Street 2: | |
Practice Address - City: | OCEAN CITY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08226-4548 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-706-1935 |
Practice Address - Fax: | 609-710-0501 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-17 |
Last Update Date: | 2021-12-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS-002704L | 207LP2900X |
NJ | 25MB02315400 | 207LA0401X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0022342000 | Other | KEYSTONE HEALTH PLAN EAST |
PA | 22-1994560 | Other | GREAT WEST HEALTHCARE |
NJ | 23-2919275 | Other | HORIZON BLUE CROSS BLUE SHIELD |
PA | 23-2919275 | Other | GREAT WEST HEALTHCARE |
PA | 33028C | Other | HORIZON MERCY |
PA | 8194307 | Other | CIGNA |
NJ | 1169961 | Other | AETNA |
PA | 33029C | Other | HORIZON MERCY |
PA | 50085446 | Other | CAPITAL BLUE CROSS |
PA | 000640054 | Medicaid | |
NJ | 22-1994560 | Other | HORIZON BLUE CROSS BLUE SHIELD |
PA | 23-2919275 | Other | DEVON |
PA | 22-1994560 | Other | DEVON |
PA | 22-1994560 | Other | PROCURA MANAGEMENT, INC. |
NJ | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
PA | 22-1994560 | Other | FIRST MCO |
NJ | 1201409 | Other | AETNA |
PA | 1659323699 | Other | BRAVO HEALTH |
PA | 22-1994560 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
PA | 23-2919275 | Other | FIRST MCO |
PA | 23-2919275 | Other | PROCURA MANAGEMENT, INC |
NJ | 23-2919275 | Other | FIRST MCO |
PA | 2551644 | Other | AETNA |
PA | 136736 | Other | PA BLUE SHIELD |
PA | 22-1994560 | Other | QUALCARE |
PA | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
PA | 136736 | Other | PERSONAL CHOICE |
PA | 1659993 | Other | CIGNA |
PA | 2189116 | Other | AETNA |
NJ | 22-1994560 | Other | FIRST MCO |
PA | 23-2919275 | Other | UNITED HEALTHCARE/OXFORD |
PA | 23-2919275 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
PA | 23-2919275 | Other | QUALCARE |
PA | 0022342000 | Other | AMERIHEALTH |
NJ | 23-2919275 | Other | UNITED HEALTHCARE/OXFORD |
PA | 5738424 | Other | FIRST HEALTH NETWORK |
PA | P00084114 | Other | RAILROAD MEDICARE |
PA | 22-1994560 | Other | FIRST MCO |
PA | 22-1994560 | Other | HEALTH AMERICA/HEALTH ASSURANCE |
NJ | 22-1994560 | Other | UNITED HEALTHCARE/OXFORD |
PA | 136736 | Medicare ID - Type Unspecified | PA MEDICARE |
PA | 000640054 | Medicaid | |
NJ | 536678RVB | Medicare PIN | |
PA | 23-2919275 | Other | GREAT WEST HEALTHCARE |
PA | 33028C | Other | HORIZON MERCY |