Provider Demographics
NPI:1932199361
Name:GRUTZMACHER, JUNE EDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:EDITH
Last Name:GRUTZMACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-1629
Mailing Address - Country:US
Mailing Address - Phone:609-397-0007
Mailing Address - Fax:609-397-0696
Practice Address - Street 1:173 N UNION ST
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530
Practice Address - Country:US
Practice Address - Phone:609-397-0007
Practice Address - Fax:609-397-0696
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47890207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3597507OtherOXFORD
NJ3369102Medicaid
NJ479108Medicare ID - Type Unspecified
E53102Medicare UPIN