Provider Demographics
NPI:1669876793
Name:DELROSARIO, GLENN TWAIN MANANSALA
Entity type:Individual
Prefix:MR
First Name:GLENN TWAIN
Middle Name:MANANSALA
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1454
Mailing Address - Country:US
Mailing Address - Phone:732-306-8521
Mailing Address - Fax:
Practice Address - Street 1:174 OVERLOOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1454
Practice Address - Country:US
Practice Address - Phone:732-306-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant