Provider Demographics
NPI:1164790044
Name:TOBIAS, GLEN LAWRENCE (RD)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:LAWRENCE
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SOUTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6442
Mailing Address - Country:US
Mailing Address - Phone:973-971-6898
Mailing Address - Fax:
Practice Address - Street 1:111 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6097
Practice Address - Country:US
Practice Address - Phone:973-971-6898
Practice Address - Fax:973-290-7668
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT816401133V00000X
NJ816401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered