Fennelly, Glenn Joseph

Fennelly, Glenn Joseph is an individual health care provider with primary practice located at 1400 Pelham Pkwy S , Bronx NY 10461-1138. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases. Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases is his primary health care specialty. Fennelly, Glenn Joseph can be contacted via phone (718) 918-3060.

Contact Information

Primary practice address
1400 Pelham Pkwy S Bronx NY 10461-1138
Phone: (718) 918-3060
Fax: (718) 918-4469
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X S7213 Texas
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 177223-1 New York
Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases 2080P0208X S7213 Texas

Profile Details

NPI number 1538220678
LBN Legal business name Fennelly, Glenn Joseph
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2006
Last updated Jul 2nd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538220678 NPPES
Minnesota MEDICAID 01484248

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