Provider Demographics
NPI:1811341852
Name:GROVER, RAJ K (DPM)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:K
Last Name:GROVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 BEACH RD STE D
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1733
Mailing Address - Country:US
Mailing Address - Phone:631-405-3325
Mailing Address - Fax:631-237-3164
Practice Address - Street 1:147 BEACH ROAD- SUITE D
Practice Address - Street 2:WESTHAMPTON BEACH
Practice Address - City:11978
Practice Address - State:NY
Practice Address - Zip Code:11978
Practice Address - Country:US
Practice Address - Phone:631-405-3325
Practice Address - Fax:631-237-3164
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSN007036213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery