Healthcare Provider Details

I. General information

NPI: 1891858353
Provider Name (Legal Business Name): LAURENCE D GROGIN D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 FRANKLIN LAKES RD
FRANKLIN LAKES NJ
07417-1100
US

IV. Provider business mailing address

936 FRANKLIN LAKES RD
FRANKLIN LAKES NJ
07417-2153
US

V. Phone/Fax

Practice location:
  • Phone: 201-888-4946
  • Fax: 201-847-0059
Mailing address:
  • Phone: 201-888-4946
  • Fax: 201-847-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00019600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00222300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: