Healthcare Provider Details

I. General information

NPI: 1134438310
Provider Name (Legal Business Name): ROBERT MICHAEL GRIFE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COUNTRY CLUB CT
CHERRY HILL NJ
08003-3310
US

IV. Provider business mailing address

23 N DELSEA DR UNIT B
CLAYTON NJ
08312-1637
US

V. Phone/Fax

Practice location:
  • Phone: 609-350-6680
  • Fax: 609-317-4868
Mailing address:
  • Phone: 856-423-7000
  • Fax: 856-423-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MICHAEL GRIFE
Title or Position: SOLE MEMBER
Credential: MD
Phone: 609-509-3445