Glenn R Provdo, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00149000 Issued in NJ

Practice address

2446 Church Rd
Suite 2C
Toms River, NJ 08753-8182

Phone

(732) 255-8637

Fax

(609) 698-6813

NPI assigned

Apr 5, 2007

Sex

Male

Sole proprietor

Yes

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": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467574814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2446 CHURCH RD",
            "address_2": "SUITE 2C",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087538182",
            "telephone_number": "732-255-8637",
            "fax_number": "609-698-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2446 CHURCH RD",
            "address_2": "SUITE 2C",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087538182",
            "telephone_number": "732-255-8637",
            "fax_number": "609-698-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVDO",
        "first_name": "GLENN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00149000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Promed Preferred MD Professional Corporation
• Promed Preferred NJ P.C.
• Promed Preferred Oh LLC
• Prosper Health Medical Services East PC
• Melissa Prosperi, ACHE,ATSA
• Providence Chiropractic and Rehab Center
• PSM Healthcare Services LLC (Fyzical Therapy and Balance Center)
• Psychiatronics LLC
• Psychological & Behavioral HLTH Ctr George a Peters
• PT at Toms LLC

• Podiatrist in Toms River, NJ
• Providers in Toms River, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.