Provider Demographics
NPI:1174690382
Name:MYRON FREEMAN DDS & NORMAN H GROLNICK DDS
Entity Type:Organization
Organization Name:MYRON FREEMAN DDS & NORMAN H GROLNICK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST CORP SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-848-6630
Mailing Address - Street 1:40 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097
Mailing Address - Country:US
Mailing Address - Phone:856-848-6630
Mailing Address - Fax:856-848-7294
Practice Address - Street 1:40 ELM AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097
Practice Address - Country:US
Practice Address - Phone:856-848-6630
Practice Address - Fax:856-848-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6433122300000X
NJ9145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty