Active NPI
Glenn Martin
- Occupational Therapist
- South Orange, NJ
National Provider Identifier
1578827374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 010100-1
- Practice address
- 162 Garfield PL
South Orange, NJ 07079-2107 - Phone
- (973) 763-0882
- NPI assigned
- Jun 27, 2012
- Last updated
- Mar 14, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 010100-1 | NY | Primary |
Addresses
Primary practice location
162 Garfield PL
South Orange, NJ 07079-2107
Mailing address
162 Garfield PL
South Orange, NJ 07079-2107
Phone (973) 763-0882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010100 | NY | MD | Occupational Therapy Assistant |
| 010100-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1578827374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "162 GARFIELD PL",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "070792107",
"telephone_number": "973-763-0882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 GARFIELD PL",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "070792107",
"telephone_number": "973-763-0882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "GLENN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-27",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "010100-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.