Provider Demographics
NPI:1083732887
Name:GRUNDY, HEIDI JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JANE
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VREELAND DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2620
Mailing Address - Country:US
Mailing Address - Phone:609-688-9200
Mailing Address - Fax:609-688-9234
Practice Address - Street 1:10 VREELAND DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2620
Practice Address - Country:US
Practice Address - Phone:609-688-9200
Practice Address - Fax:609-688-9234
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00626800111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095273UPRMedicare ID - Type Unspecified