Provider Demographics
NPI:1609988336
Name:GRILL, JOSHUA DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:GRILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAG HAMMARSKJOLD BLVD
Mailing Address - Street 2:STE 5
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5222
Mailing Address - Country:US
Mailing Address - Phone:732-780-0769
Mailing Address - Fax:732-414-7800
Practice Address - Street 1:1 DAG HAMMARSKJOLD BLVD
Practice Address - Street 2:STE 5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5222
Practice Address - Country:US
Practice Address - Phone:732-780-0769
Practice Address - Fax:732-414-7800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005589213ES0131X
NJMD002665213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02217701Medicaid
NJ8774404Medicaid
U85945Medicare UPIN
NY02217701Medicaid
NJ8774404Medicaid