Provider Demographics
NPI:1922291913
Name:GRISWOLD, KAREN L (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 S 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9542
Mailing Address - Country:US
Mailing Address - Phone:609-748-7300
Mailing Address - Fax:609-748-7919
Practice Address - Street 1:741 S 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9542
Practice Address - Country:US
Practice Address - Phone:609-748-7300
Practice Address - Fax:609-748-7919
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00065200363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ190497Medicare PIN
NJ084586B8MMedicare UPIN