Provider Demographics
NPI:1861537219
Name:GLASS, JOEL B (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:B
Last Name:GLASS
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 1:8004 LINCOLN DR W STE E
Mailing Address - Street 2:RT 73 & GREENTREE ROAD
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3213
Mailing Address - Country:US
Mailing Address - Phone:856-983-3830
Mailing Address - Fax:856-983-3837
Practice Address - Street 1:8004 LINCOLN DR W STE E
Practice Address - Street 2:RT 73 & GREENTREE ROAD
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3213
Practice Address - Country:US
Practice Address - Phone:856-983-3830
Practice Address - Fax:856-983-3837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02629200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD96381Medicare UPIN