Healthcare Provider Details

I. General information

NPI: 1811077092
Provider Name (Legal Business Name): GRANT L BABBITT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MARTINE AVE
FANWOOD NJ
07023-1622
US

IV. Provider business mailing address

120 S MARTINE AVE
FANWOOD NJ
07023-1622
US

V. Phone/Fax

Practice location:
  • Phone: 908-680-9600
  • Fax: 908-680-9601
Mailing address:
  • Phone: 908-680-9600
  • Fax: 908-680-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC001622
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: