Provider Demographics
NPI:1912019332
Name:GRUBER, MELVIN SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:SAUL
Last Name:GRUBER
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 1:900 ROUTE 168
Mailing Address - Street 2:SUITE F-6
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-227-7488
Mailing Address - Fax:856-228-3476
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:SUITE F-6
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-227-7488
Practice Address - Fax:856-228-3476
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02362400207N00000X
PAMD009679E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ019039C2BOtherMEDICARE BILLING NO.
NJ16017OtherAETNA
NJ1145452005OtherCIGNA
C54077Medicare UPIN
NJ1145452005OtherCIGNA