Provider Demographics
NPI:1821385568
Name:GLANTZ, ERIC J (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:GLANTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6145
Mailing Address - Country:US
Mailing Address - Phone:732-703-6622
Mailing Address - Fax:732-722-1024
Practice Address - Street 1:860 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6145
Practice Address - Country:US
Practice Address - Phone:732-703-6622
Practice Address - Fax:732-722-1024
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB09366800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program