Provider Demographics
NPI:1629299615
Name:ROSE, LANE GRUBER (MD)
Entity Type:Individual
Prefix:DR
First Name:LANE
Middle Name:GRUBER
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1131 BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-450-0042
Mailing Address - Fax:732-450-0052
Practice Address - Street 1:1131 BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-450-0042
Practice Address - Fax:732-450-0052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075118002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry