Individual
GLENMAR NISPEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
17 ACADEMY ST STE 312, NEWARK, NJ 07102-2934
(973) 648-6808
Mailing address
81 MORRIS AVE APT 55, SPRINGFIELD, NJ 07081-1431
(973) 704-7756
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT40QA01119400
NJ
Other
Enumeration date
02/26/2007
Last updated
07/08/2007
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