Provider Demographics
NPI:1235189630
Name:GRODER, HOWARD B (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:B
Last Name:GRODER
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 1:181 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2900
Mailing Address - Country:US
Mailing Address - Phone:973-667-1500
Mailing Address - Fax:973-667-3656
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-667-1500
Practice Address - Fax:973-667-3656
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA030921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06405Medicare UPIN
NJ045416Medicare ID - Type Unspecified