# DR. GLENN G GABISAN

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1346227428
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | MA069963 | NJ | Yes |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | 25MA06996300 | NJ | — |

## Other

- **Enumeration date:** 12/29/2005
- **Last updated:** 12/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0047635 | — | NJ |
| 05 | — | 3222403 | — | NJ |
| 01 | — | 7679694 | AETNA ID\# | NJ |
| 01 | — | CC3884 | RR MEDICARE GRP\# | NJ |
| 01 | — | J34051 | HEALTHNET ID\# | NJ |
| 01 | — | P00163993 | RR MEDICARE | NJ |
| 01 | — | P3362517 | OXFORD ID\# | NJ |