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NPI Code Detail

MEDICARE: THADDEUS J GRABOWY MD

MEDICARE: THADDEUS J GRABOWY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician25MA05933800NJ
2207R00000XInternal Medicine Physician25MA05933800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679570006
Entity Type Code : Individual
Provider Name (Legal Business Name) : THADDEUS J GRABOWY MD
Provider Business Mailing Address
First Line : PO BOX 249
Second Line :
City : RED BANK
State : NJ
Zip : 07701-0249
Country : US
Telephone Number : 732-741-3600
Fax Number : 732-741-6079
Provider Business Practice Location Address
First Line : 4 HARTFORD DR
Second Line :
City : TINTON FALLS
State : NJ
Zip : 07701-4929
Country : US
Telephone Number : 732-741-3600
Fax Number : 732-741-6079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 12/14/2017

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