Provider Demographics
NPI:1043323181
Name:GRUBMAN, JEROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:
Last Name:GRUBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARSONAGE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2429
Mailing Address - Country:US
Mailing Address - Phone:732-494-9400
Mailing Address - Fax:
Practice Address - Street 1:10 PARSONAGE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2429
Practice Address - Country:US
Practice Address - Phone:732-494-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02705000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMS188OtherOXFORD ID #
NJ0563124OtherAETNA HMO ID #
NJ4207487OtherAETNA PPO ID #
NY288071OtherEMPIRE BC/BS OF NY EDISON
NY288072OtherEMPIRE BC/BS OF NY OB
NJ340005177OtherRR MEDICARE ID #
NJ5709962OtherGHI PPO
NJMS188OtherOXFORD ID #
NJ4207487OtherAETNA PPO ID #