Provider Demographics
NPI:1437370004
Name:GROVER, SURENDER M (MD)
Entity Type:Individual
Prefix:
First Name:SURENDER
Middle Name:M
Last Name:GROVER
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 1:979 HIGHWAY 9 NORTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:732-721-7700
Mailing Address - Fax:732-721-2300
Practice Address - Street 1:979 HIGHWAY 9 NORTH
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-721-7700
Practice Address - Fax:732-721-2300
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26160207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2803402Medicaid
NJD07208Medicare UPIN
NJ2803402Medicaid