Provider Demographics
NPI:1811034788
Name:ROOPINDER K. GREWAL, MD, LLC
Entity Type:Organization
Organization Name:ROOPINDER K. GREWAL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-565-1500
Mailing Address - Street 1:49 VERONICA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6802
Mailing Address - Country:US
Mailing Address - Phone:732-565-1500
Mailing Address - Fax:732-565-1501
Practice Address - Street 1:49 VERONICA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6802
Practice Address - Country:US
Practice Address - Phone:732-565-1500
Practice Address - Fax:732-565-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048020Medicare PIN
NJG13492Medicare UPIN