Provider Demographics
NPI:1265495980
Name:GROCHOWALSKI, TOMASZ K (MD)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:K
Last Name:GROCHOWALSKI
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 1:2045 STATE ROUTE 35
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2069
Mailing Address - Country:US
Mailing Address - Phone:732-721-5511
Mailing Address - Fax:732-721-2007
Practice Address - Street 1:2045 STATE ROUTE 35
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2069
Practice Address - Country:US
Practice Address - Phone:732-721-5511
Practice Address - Fax:732-721-2007
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3000218OtherOXFORD
NJ4986761OtherCIGNA
NJ7164118OtherAETNA
NJ009010Medicare ID - Type Unspecified
NJG67273Medicare UPIN