Provider Demographics
NPI:1710988852
Name:GRABIAK, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GRABIAK
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 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:805 COOPER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3814
Practice Address - Country:US
Practice Address - Phone:856-882-1201
Practice Address - Fax:856-424-2218
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04602500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2098903Medicaid
NJ184523Medicare ID - Type Unspecified
NJ2098903Medicaid