Individual
MR. GLENN EASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CO,BOCPO,LPO
Contact information
Practice address
141 SILOAM RD, FREEHOLD, NJ 07728-8608
(800) 718-7856
Mailing address
141 SILOAM RD, FREEHOLD, NJ 07728-8608
(646) 262-1845
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
45PO00013900
NJ
Other
Enumeration date
03/19/2007
Last updated
12/13/2012
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