Provider Demographics
NPI:1063443844
Name:GRILL, LAWRENCE JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOEL
Last Name:GRILL
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 1:1 ROUTE 70 STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5895
Mailing Address - Country:US
Mailing Address - Phone:732-367-8272
Mailing Address - Fax:732-367-3693
Practice Address - Street 1:1 ROUTE 70 STE 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5895
Practice Address - Country:US
Practice Address - Phone:732-367-8272
Practice Address - Fax:732-367-3693
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine