Provider Demographics
NPI:1336526094
Name:GROB, GAIL RUTH (HAD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:RUTH
Last Name:GROB
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5961
Mailing Address - Country:US
Mailing Address - Phone:732-363-5991
Mailing Address - Fax:732-364-8590
Practice Address - Street 1:1000 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5961
Practice Address - Country:US
Practice Address - Phone:732-363-5991
Practice Address - Fax:732-364-8590
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00037400237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist