Provider Demographics
NPI:1770571986
Name:GRIFFIN, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GRIFFIN
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 1:55 MADISON AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-993-9536
Mailing Address - Fax:973-998-4237
Practice Address - Street 1:55 MADISON AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-993-9536
Practice Address - Fax:973-998-4237
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04827900207R00000X
NJ25MA04590600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7782101Medicaid
NJ073027Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NJ553032R2YMedicare ID - Type Unspecified