Glenn A Gmyrek (NPI# 1740249143, PAC ID# 1153485537) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1740249143 |
| PAC ID by PECOS | 1153485537 |
| Professional Enrollment ID | I20100920000656 |
| Full Name | Glenn A Gmyrek |
| Organization Legal Name | SOVEREIGN MEDICAL GROUP LLC |
| Address |
1124 E Ridgewood Ave Suite 105 Ridgewood NJ 07450-3915 |
| Phone Number | 2018558498 |
| Gender | M |
| Medical School | COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS |
| Graduation Year | 1996 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 1456535392 |
| Number of Group Practice Members | 38 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 310019 | ST JOSEPH'S HOSPITAL AND MEDICAL CENTER |
| 310017 | CHILTON MEDICAL CENTER |
| 310012 | VALLEY HOSPITAL |
| 310001 | HACKENSACK UNIVERSITY MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1124 E Ridgewood Ave, Suite 105, Ridgewood, NJ 07450-3915 | 2018558498 | SOVEREIGN MEDICAL GROUP LLC |
| 246 Hamburg Tpke, Suite 308, Wayne, NJ 07470-2159 | 9739561555 | SOVEREIGN MEDICAL GROUP LLC |
| Organization Legal Name | SOVEREIGN MEDICAL GROUP LLC |
| Physicians | 41 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Karen M Bellapianta | Otolaryngology | Sovereign Medical Group LLC | 85 Harristown, Suite 105, Glen Rock, NJ 07452-3307 |
| Raffaella L Kalishman | Internal Medicine | Sovereign Medical Group LLC | 85 Harristown Rd, Suite 104, Glen Rock, NJ 07452-3323 |
| Elliot L Shulman | Urology | Sovereign Medical Group LLC | 807 Kennedy Blvd, Suite A, Bayonne, NJ 07002-2983 |
| Albert O Kwon | Colorectal Surgery (proctology) | Sovereign Medical Group LLC | 15-01 Broadway Route 4 W, Suite 1, Fairlawn, NJ 07410-6006 |
| Andranik Howhannesian | Urology | Sovereign Medical Group LLC | 14 -01 Broadway, Suite 3, Fair Lawn, NJ 07410-2008 |
| Jerry Silver | Otolaryngology | Sovereign Medical Group LLC | 15 -01 Broadway Rt 4, Fairlawn, NJ 07410-6006 |
| Joel Abramowitz | Urology | Sovereign Medical Group LLC | 8100 Kennedy Blvd, North Bergen, NJ 07047-4254 |
| Richard Maggio | Urology | Sovereign Medical Group LLC | 2071 Clove Rd J, Staten Island, NY 10304-1612 |
| Scott A Goler | Podiatry | Sovereign Medical Group LLC | 265 E 33rd St, Paterson, NJ 07504-1668 |
| Morteza Shahamat | Internal Medicine | Sovereign Medical Group LLC | 400 Franklin Tpke, Suite 104, Mahwah, NJ 07430-3517 |
| Street Address |
1124 E RIDGEWOOD AVE SUITE 105 |
| City | RIDGEWOOD |
| State | NJ |
| Zip | 07450-3915 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Natasha Chhabra | Gastroenterology | Gastroenterology Associates of New Jersey LLC | 1124 E Ridgewood Ave, Suite 203, Ridgewood, NJ 07450-3915 |
| Mitul Suresh Patel | Vascular Surgery | 1124 E Ridgewood Ave, Suite 104, Ridgewood, NJ 07450-3915 | |
| Maria Tenebruso | Physician Assistant | New Jersey Endovascular Therapeutics PC | 1124 E Ridgewood Ave, Suite 104, Ridgewood, NJ 07450-3915 |
| Rakesh Sharma | Pulmonary Disease | Valley Pulmonary and Sleep Disorder Center | 1124 E Ridgewood Ave, Suite 103, Ridgewood, NJ 07450-3943 |
| Joshua Bernheim | Vascular Surgery | New Jersey Endovascular Therapeutics PC | 1124 E Ridgewood Ave, Suite 104, Ridgewood, NJ 07450-3915 |
| Cheryl Burnett | Nurse Practitioner | Valley Pulmonary and Sleep Disorder Center | 1124 E Ridgewood Ave, Suite 103, Ridgewood, NJ 07450-3943 |
| Daniel J Char | General Surgery | New Jersey Endovascular Therapeutics PC | 1124 E Ridgewood Ave, Suite 104, Ridgewood, NJ 07450-3915 |
| Amita Kalia-sharma | Internal Medicine | Valley Pulmonary and Sleep Disorder Center | 1124 E Ridgewood Ave, Suite 103, Ridgewood, NJ 07450-3943 |
| Tsui Yuen | Physician Assistant | New Jersey Endovascular Therapeutics PC | 1124 E Ridgewood Ave, Suite 104, Ridgewood, NJ 07450-3915 |
| Joseph Disaverio | General Surgery | 1124 E Ridgewood Ave, Suite 203, Ridgewood, NJ 07450-3915 | |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer Marchese Tumminello | Clinical Social Worker | 535 E Ridgewood, Suite 10, Ridgewood, NJ 07450 | |
| Josephine Jarolmen | Clinical Social Worker | 115 Pine St, Ridgewood, NJ 07450-1619 | |
| Jasmine Aloni Cohn | Clinical Social Worker | 115 Pine St, Suite 300, Ridgewood, NJ 07450-1619 | |
| Susan J Syvarth | Clinical Social Worker | 115 Pine St, Ridgewood, NJ 07450-1619 | |
| Bonnie Malajian | Clinical Social Worker | 428 Cambridge Rd, Ridgewood, NJ 07450-1805 | |
| Douglas Liva | Ophthalmology | Liva Eye Center LLC | 625 Franklin Tpke, Ridgewood, NJ 07450-1913 |
| Rosemary Frasco | Optometry | Liva Eye Center LLC | 625 Franklin Tpke, Ridgewood, NJ 07450-1913 |
| Mahros K Isaac | Physical Therapy | Progressive Rehab and Home Care Pt and Ot Pllc | 537 Banta St, Ridgewood, NJ 07450-1918 |
| Eui-sun L Yoon | Psychiatry | 589 Franklin Tpke, Suite 11, Ridgewood, NJ 07450-1928 | |
| Amy W. Stevens | Dermatology | Northern Bergen Dermatology Group Pa | 400 Route 17, Ridgewood, NJ 07450-2010 |
| Find all physicians in zip 07450 | |||
| City | RIDGEWOOD |
| Zip Code | 07450 |
| Specialty | UROLOGY |
| City + Specialty | RIDGEWOOD + UROLOGY |
Please comment or provide details below to improve the information on Glenn A Gmyrek.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.