Basic Information
| Provider Information | |||||||||
| NPI: | 1346483815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLASS | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 BERGEN ST STE 7100 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739722400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 185 S ORANGE AVE | ||||||||
| Address2: | MSB G526 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739726293 | ||||||||
| FaxNumber: | 9739726803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2009 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 25MA09883500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 25MA09883500 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | 25MA09883500 | NJ | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.