MEDICARE: LAURENCE D. GROGIN

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
1	171100000X	Acupuncturist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1790319424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURENCE D. GROGIN

Provider Business Mailing Address
First Line	:	936 FRANKLIN LAKE RD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-2153
Country	:	US
Telephone Number	:	201-847-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 FRANKLIN LAKE RD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-2153
Country	:	US
Telephone Number	:	201-847-2341
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURENCE D GROGIN
Credential	:	D.C., L.AC.
Telephone Number	:	201-847-2341

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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