Provider Demographics
NPI:1891126884
Name:JOSHUA GRILL DPM PC
Entity Type:Organization
Organization Name:JOSHUA GRILL DPM PC
Other - Org Name:PAMPERING PODIATRIST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-780-0769
Mailing Address - Street 1:1 DAG HAMMARSKJOLD BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5221
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:SUITE 5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5221
Practice Address - Country:US
Practice Address - Phone:732-780-0769
Practice Address - Fax:732-414-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00266500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty