Provider Demographics
NPI:1730111451
Name:FREAS, GLENN
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:FREAS
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 1:900 ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-5259
Mailing Address - Country:US
Mailing Address - Phone:609-884-4357
Mailing Address - Fax:609-884-4377
Practice Address - Street 1:900 ROUTE 109
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5259
Practice Address - Country:US
Practice Address - Phone:609-884-4357
Practice Address - Fax:609-884-4377
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06853800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7806604Medicaid
NJ7806604Medicaid