NPIMap

Organization Active NPI

Glutality Provider Group of New Jersey, PA.

  • Internal Medicine Physician
  • Neptune, NJ
National Provider Identifier
1396335675
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GLUTALITY PROVIDER GROUP OF NEW JERSEY, PA.
Practice address
3600 Route 66 Ste 150
Neptune, NJ 07753-2645
Phone
(561) 678-2026
NPI assigned
Jan 21, 2021
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Mitchell Stottland
Title
Owner
Phone
(561) 678-2026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3600 Route 66 Ste 150
Neptune, NJ 07753-2645

Mailing address

401 Fairway Dr Ste 200
Deerfield Beach, FL 33441-1800
Phone (561) 678-2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, AZ, TN, GA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20210504002149 NJ Part B Supplier - Clinic/Group Practice 1759790793 Receives reassigned benefits from 4 practitioners
Practice locations: Neptune, NJ
O20230607001914 AZ Part B Supplier - Clinic/Group Practice 1759790793 Receives reassigned benefits from 1 practitioner
Practice locations: Mesa, AZ
O20230621000631 TN Part B Supplier - Clinic/Group Practice 1759790793 Receives reassigned benefits from 1 practitioner
Practice locations: Murfreesboro, TN
O20230804000722 GA Part B Supplier - Clinic/Group Practice 1759790793 Receives reassigned benefits from 3 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

510 Clinton Sq
Ste 200
Rochester, NY 14604
Phone (561) 849-4460

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1396335675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 FAIRWAY DR STE 200",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334411800",
            "telephone_number": "561-678-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 66 STE 150",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532645",
            "telephone_number": "561-678-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLUTALITY PROVIDER GROUP OF NEW JERSEY, PA.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "STOTTLAND",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-678-2026"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neptune, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.