Individual
CRAIG STEVEN GLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
65 W JIMMIE LEEDS RD, POMONA, NJ 08240-9102
(609) 677-9729
(609) 652-6270
Mailing address
72 W JIMMIE LEEDS RD, SUITE 1100, GALLOWAY, NJ 08205-9406
(609) 677-9729
(609) 652-7153
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
25MA05779700
NJ
2085R0202X
Diagnostic Radiology Physician
25MA05779700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300081001
RAILROAD MEDICARE
NJ
05
—
5335108
—
NJ
01
—
P00758300
RAILROAD MEDICARE
NJ
01
—
P00847775
RAILROAD MEDICARE
NJ
Enumeration date
08/15/2006
Last updated
11/22/2011
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