Provider Demographics
NPI:1134116478
Name:CALEM-GRUNAT, JACLYN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:A
Last Name:CALEM-GRUNAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1749
Mailing Address - Country:US
Mailing Address - Phone:201-445-8822
Mailing Address - Fax:201-447-7058
Practice Address - Street 1:20 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1749
Practice Address - Country:US
Practice Address - Phone:201-445-8822
Practice Address - Fax:201-447-7058
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062663002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6802001Medicaid
NJ787173A4HMedicare PIN
G19615Medicare UPIN