Provider Demographics
NPI:1831983626
Name:GLUMICIC, ANJA (PA-C)
Entity type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:GLUMICIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17527 WEXFORD TER APT 5J
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2848
Mailing Address - Country:US
Mailing Address - Phone:347-475-2406
Mailing Address - Fax:
Practice Address - Street 1:17527 WEXFORD TER APT 5J
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2848
Practice Address - Country:US
Practice Address - Phone:347-475-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant