Healthcare Provider Details

I. General information

NPI: 1306042130
Provider Name (Legal Business Name): ROBERT MICHAEL GRIFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
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: 609-823-9505
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 Number25MA08257100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: