Provider Demographics
NPI:1831100999
Name:WAINEN, GLEN P (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:P
Last Name:WAINEN
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 1:57 US HIGHWAY 46
Mailing Address - Street 2:STE 107
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2695
Mailing Address - Country:US
Mailing Address - Phone:908-813-9700
Mailing Address - Fax:908-813-2861
Practice Address - Street 1:57 US HIGHWAY 46
Practice Address - Street 2:STE 107
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-813-9700
Practice Address - Fax:908-813-2861
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026094DARMedicare ID - Type Unspecified
NJ0884120001Medicare NSC
G54586Medicare UPIN