Provider Demographics
NPI:1700607058
Name:GLANTZ, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:GLANTZ
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 1:132 HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1327
Mailing Address - Country:US
Mailing Address - Phone:216-456-7814
Mailing Address - Fax:
Practice Address - Street 1:132 HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1327
Practice Address - Country:US
Practice Address - Phone:216-456-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant