Provider Demographics
NPI:1497707087
Name:GRUCZYNSKI, TOMASZ ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMASZ
Middle Name:ADAM
Last Name:GRUCZYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:ADAM
Other - Last Name:GRUCZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:508 HAMBURG TPKE STE 106
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8482
Mailing Address - Country:US
Mailing Address - Phone:973-942-7800
Mailing Address - Fax:
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8482
Practice Address - Country:US
Practice Address - Phone:973-942-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9044400Medicaid