Provider Demographics
NPI:1053913095
Name:GLOMAR MEDICAL INC.
Entity type:Organization
Organization Name:GLOMAR MEDICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:321-543-9830
Mailing Address - Street 1:341 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6405
Mailing Address - Country:US
Mailing Address - Phone:321-543-9830
Mailing Address - Fax:
Practice Address - Street 1:341 ALLISON DR
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-6405
Practice Address - Country:US
Practice Address - Phone:321-543-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty