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Organization
ADVANCED PODIATRY PA
Active
Organization
ADVANCED PODIATRY PA
Active
Other names
Glenn A Davison DPM PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN A DAVISON DPM (PRESIDENT)
(908) 688-5577
Entity
Organization
Contact information
Practice address
1308 MORRIS AVENUE, SUITE 104, UNION, NJ 07083-3331
(908) 688-5577
(908) 688-2755
Mailing address
1308 MORRIS AVENUE, SUITE 104, UNION, NJ 07083-3331
(908) 688-5577
(908) 688-2755
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00196300
NJ
213E00000X
Podiatrist
25MD00257000
NJ
213E00000X
Podiatrist
N0046131
NY
213E00000X
Podiatrist
N006069
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0859237000
AMERIHEALTH
—
01
—
1138221
HORIZON HEALTH
NJ
05
—
8261903
—
NJ
01
—
985507
AMERIHEALTH
—
Enumeration date
08/30/2006
Last updated
12/07/2007
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