Healthcare Provider Details

I. General information

NPI: 1265495980
Provider Name (Legal Business Name): TOMASZ K GROCHOWALSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 STATE ROUTE 35 SUITE 202
SOUTH AMBOY NJ
08879-2069
US

IV. Provider business mailing address

2045 STATE ROUTE 35 SUITE 202
SOUTH AMBOY NJ
08879-2069
US

V. Phone/Fax

Practice location:
  • Phone: 732-721-5511
  • Fax: 732-721-2007
Mailing address:
  • Phone: 732-721-5511
  • Fax: 732-721-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA065561
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: