Provider Demographics
NPI:1083980312
Name:GREUNER MEDICAL OF NJ PC
Entity Type:Organization
Organization Name:GREUNER MEDICAL OF NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-286-6600
Mailing Address - Street 1:PO BOX 28200
Mailing Address - Street 2:LOCKBOX ACCT NJ
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8200
Mailing Address - Country:US
Mailing Address - Phone:888-286-6600
Mailing Address - Fax:800-565-9415
Practice Address - Street 1:555 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7475
Practice Address - Country:US
Practice Address - Phone:888-286-6600
Practice Address - Fax:800-565-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 208G00000X
NJ25MA08845600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08845600OtherLICENSE