Provider Demographics
NPI:1811259153
Name:GROGAN, ROSWITHA R (MED)
Entity type:Individual
Prefix:MRS
First Name:ROSWITHA
Middle Name:R
Last Name:GROGAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2639
Mailing Address - Country:US
Mailing Address - Phone:201-315-2103
Mailing Address - Fax:
Practice Address - Street 1:93 PALMER AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2639
Practice Address - Country:US
Practice Address - Phone:201-315-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist