Individual
GLENN BEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
48 HIAWATHA BLVD, OAKLAND, NJ 07436-2919
(619) 867-6094
Mailing address
48 HIAWATHA BLVD, OAKLAND, NJ 07436-2919
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
45PO00017000
NJ
Other
Enumeration date
09/18/2017
Last updated
09/18/2017
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