Provider Demographics
NPI:1659599918
Name:GLASS, STEVEN JEROMEG (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JEROMEG
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:93 REMSTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2940
Mailing Address - Country:US
Mailing Address - Phone:856-358-8419
Mailing Address - Fax:856-358-8419
Practice Address - Street 1:130 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4159
Practice Address - Country:US
Practice Address - Phone:856-566-9000
Practice Address - Fax:856-566-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA 442892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2269708Medicaid
NJAG2705486OtherDEA
NJAG2705486OtherDEA
PA2269708Medicaid