Provider Demographics
NPI:1326139247
Name:GRUENBERG, MARTIN J (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:GRUENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-776-1603
Mailing Address - Fax:480-455-4940
Practice Address - Street 1:2550 N THUNDERBIRD CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1214
Practice Address - Country:US
Practice Address - Phone:480-776-1603
Practice Address - Fax:480-455-4940
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05665000207P00000X, 207Q00000X
AZ44962083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8486905Medicaid
AZZ126048Medicare PIN
AZZ120952Medicare PIN
NJ440166Medicare ID - Type Unspecified
NJ8486905Medicaid
AZZ125930Medicare UPIN