Provider Demographics
NPI:1245257732
Name:D A SGROI MD PA
Entity type:Organization
Organization Name:D A SGROI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:SGROI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-0077
Mailing Address - Street 1:27 SHINNECOCK TRAIL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:973-790-0077
Mailing Address - Fax:973-653-3940
Practice Address - Street 1:401 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-790-0077
Practice Address - Fax:973-653-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32756207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2989204Medicaid
NJ5G165885Medicare ID - Type Unspecified
NJ2989204Medicaid