Kenneth A Gluck, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

22DI02379600 Issued in NJ

Practice address

110 Bergen St
Room C-781
Newark, NJ 07103-2495

Phone

(973) 972-4214

Fax

(973) 972-3884

NPI assigned

Aug 5, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1174789440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BERGEN ST",
            "address_2": "ROOM C-781",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032495",
            "telephone_number": "973-972-4214",
            "fax_number": "973-972-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BERGEN ST",
            "address_2": "ROOM C-781",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032495",
            "telephone_number": "973-972-4214",
            "fax_number": "973-972-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLUCK",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-05",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "22DI02379600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Gleyzer, PSYD
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• Elikem Kay Glover
• Glowing Hearts Home Care Services
• Leeann M Glozman, NP
• Talya Gluck, DMD
• Maria Cynthia Inocencio Gocon, OT
• Gocopetra Care Consultant LLC
• Glenn P Godart, DMD
• Maxwell Alan Godek, MD

• Periodontics in Newark, NJ
• Providers in Newark, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.