Provider Demographics
NPI:1134277601
Name:GRITSMAN, ANDREY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:GRITSMAN
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:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:LEWISBERRY
Mailing Address - State:PA
Mailing Address - Zip Code:17339-0266
Mailing Address - Country:US
Mailing Address - Phone:800-223-0925
Mailing Address - Fax:
Practice Address - Street 1:223 NORTH VAN DIEN AVENUE
Practice Address - Street 2:VALLEY HOSPITAL
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-447-8242
Practice Address - Fax:201-447-8657
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ60261174400000X
NJ25MA06026100207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6067000Medicaid
NJ531599BUPMedicare PIN
NJ6067000Medicaid