Provider Demographics
NPI:1932361110
Name:GLOTH, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:GLOTH
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 1:780 RT. 37 WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1856
Mailing Address - Country:US
Mailing Address - Phone:732-797-1855
Mailing Address - Fax:732-797-1856
Practice Address - Street 1:780 RT 37 WEST
Practice Address - Street 2:SUITE 200
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1856
Practice Address - Country:US
Practice Address - Phone:732-797-1855
Practice Address - Fax:732-797-1856
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA08818800207W00000X
NJ25MA08818800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ190089SDIOtherMEDICARE IDENTIFIER