Provider Demographics
NPI:1639527526
Name:GRG MEDICAL LLC
Entity Type:Organization
Organization Name:GRG MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-742-7300
Mailing Address - Street 1:618 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3638
Mailing Address - Country:US
Mailing Address - Phone:215-742-7300
Mailing Address - Fax:215-725-2072
Practice Address - Street 1:618 NICOLE DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3638
Practice Address - Country:US
Practice Address - Phone:215-742-7300
Practice Address - Fax:215-725-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies