Provider Demographics
NPI:1932112950
Name:PATTNER & GRODSTEIN MD PA
Entity Type:Organization
Organization Name:PATTNER & GRODSTEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-0446
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-567-0446
Mailing Address - Fax:201-567-8775
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-567-0446
Practice Address - Fax:201-567-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0911607Medicaid
NJ0396206Medicaid
NJ0520004Medicaid
NJ7449704Medicaid
NJ8262608Medicaid
NJ0036803Medicaid
NJC53067Medicare UPIN
NJI15727Medicare UPIN
NJ0911607Medicaid
NJD18508Medicare UPIN
NJ8262608Medicaid
NJC53065Medicare UPIN