Provider Demographics
NPI:1093861700
Name:GROCH, GEORGE SIDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SIDNEY
Last Name:GROCH
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 1:1413 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2235
Mailing Address - Country:US
Mailing Address - Phone:609-646-9447
Mailing Address - Fax:609-646-1232
Practice Address - Street 1:1413 SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2235
Practice Address - Country:US
Practice Address - Phone:609-646-9447
Practice Address - Fax:609-646-1232
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02102700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56358Medicare UPIN