Provider Demographics
NPI:1912240144
Name:GLOZMAN, LEEANN M (NP)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:M
Last Name:GLOZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CAPITAL WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2523
Mailing Address - Country:US
Mailing Address - Phone:609-303-0747
Mailing Address - Fax:609-303-0771
Practice Address - Street 1:2 CAPITAL WAY STE 220
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2523
Practice Address - Country:US
Practice Address - Phone:609-303-0747
Practice Address - Fax:609-303-0771
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305707363LA2200X
NJ26NJ00425400363LA2200X, 363L00000X
NY340807363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology