Provider Demographics
NPI:1346391422
Name:GROSBERG, SUSAN L (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:GROSBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3615
Mailing Address - Country:US
Mailing Address - Phone:610-246-2793
Mailing Address - Fax:973-532-6751
Practice Address - Street 1:38 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3615
Practice Address - Country:US
Practice Address - Phone:610-246-2793
Practice Address - Fax:973-532-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00183700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11487528OtherCAQH
PAP00327536OtherRAILROAD MEDICARE
PA000760388OtherHIGHMARK BLUE SHIELD
PA0567202000OtherPERSONAL CHOICE
NY000760388OtherEMPIRE BC BS
PA0567202000OtherPERSONAL CHOICE