Provider Demographics
NPI:1487729034
Name:GLASGOLD, MARK JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JONATHAN
Last Name:GLASGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CLEVELAND LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3049
Mailing Address - Country:US
Mailing Address - Phone:609-924-5757
Mailing Address - Fax:
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1731
Practice Address - Country:US
Practice Address - Phone:732-846-6540
Practice Address - Fax:732-846-8231
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25A0539042086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG09033Medicare UPIN