Healthcare Provider Details

I. General information

NPI: 1932199361
Provider Name (Legal Business Name): JUNE EDITH GRUTZMACHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N UNION ST
LAMBERTVILLE NJ
08530
US

IV. Provider business mailing address

173 N UNION ST
LAMBERTVILLE NJ
08530-1629
US

V. Phone/Fax

Practice location:
  • Phone: 609-397-0007
  • Fax: 609-397-0696
Mailing address:
  • Phone: 609-397-0007
  • Fax: 609-397-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA47890
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: