Provider Demographics
NPI:1801847629
Name:GLICKMAN, ALEXANDER B (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:B
Last Name:GLICKMAN
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:PO BOX 5220
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-5220
Mailing Address - Country:US
Mailing Address - Phone:732-349-3838
Mailing Address - Fax:732-349-2233
Practice Address - Street 1:215 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3604
Practice Address - Country:US
Practice Address - Phone:973-779-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06345200207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0699977OtherGHI
NJ6945805Medicaid
01000449006OtherAMERICHOICE
83783OtherAMGP
P1281074OtherOX
P00165380OtherRRM
1821709OtherUHC
2K7355OtherHEALTHNET
30148OtherUHP
0993219000OtherAMERIHEALTH
1144690OtherMHP
3544558OtherAETNA
F81992Medicare UPIN
3544558OtherAETNA