Individual
DR. GLENN M DRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
509 N BROAD ST, WOODBURY, NJ 08096-1617
(856) 848-4464
(856) 848-7023
Mailing address
509 N BROAD ST, WOODBURY, NJ 08096-1617
(856) 845-0100
(856) 848-7023
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA05686000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA56860
MEDI CAL LICENSE
NJ
05
—
6566405
—
NJ
01
—
D05550100
CDS
NJ
Enumeration date
09/14/2005
Last updated
03/07/2023
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