Provider Demographics
NPI:1457412876
Name:GRUEN, RONALD STEVEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEVEN
Last Name:GRUEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 BRACE RD
Mailing Address - Street 2:STE D
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3229
Mailing Address - Country:US
Mailing Address - Phone:856-795-7674
Mailing Address - Fax:856-795-6622
Practice Address - Street 1:1236 BRACE RD
Practice Address - Street 2:STE D
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3229
Practice Address - Country:US
Practice Address - Phone:856-795-7674
Practice Address - Fax:856-795-6622
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1129103T00000X
PAPS001860L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4348151OtherAETNA
0099425000OtherINDEP BLUE CROSS
GR424432Medicare ID - Type Unspecified