| Glenn A Gmyrek, MD | |
|
15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 | |
| (201) 791-4544 | |
| (201) 791-6585 |
| Full Name | Glenn A Gmyrek |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 30 Years |
| Location | 15-01 Broadway, Rt 4 West, Fair Lawn, New Jersey |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740249143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 25MA07435800 (New Jersey) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Joseph's Hospital And Medical Center | Paterson, NJ | Hospital |
| Chilton Medical Center | Pompton plains, NJ | Hospital |
| Valley Hospital | Ridgewood, NJ | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Sovereign Medical Group Llc | 1456535392 | 17 |
| Entity Name | Sovereign Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710282082 PECOS PAC ID: 1456535392 Enrollment ID: O20110418000519 |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn A Gmyrek, MD 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 Ph: (201) 791-4544 | Glenn A Gmyrek, MD 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 Ph: (201) 791-4544 |
Clifford B Bleustein, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 Phone: 201-791-4544 Fax: 201-791-6585 | |
Andranik Howhannesian, Urology Medicare: Accepting Medicare Assignments Practice Location: 14-01 Broadway Ste 3, Fair Lawn, NJ 07410 Phone: 201-791-4544 |