Individual
DR. GLENN JOSEPH FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 PELHAM PKWY S, BRONX, NY 10461-1138
(718) 918-3060
(718) 918-4469
Mailing address
440 RAYNOLDS ST, EL PASO, TX 79905-1613
(915) 215-4480
(915) 215-5386
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
177223-1
NY
208000000X
Pediatrics Physician
S7213
TX
2080P0208X
Pediatric Infectious Diseases Physician
Primary
S7213
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01484248
—
MN
Enumeration date
12/13/2006
Last updated
07/02/2020
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