Healthcare Provider Details

I. General information

NPI: 1487650149
Provider Name (Legal Business Name): SLOBODAN GRUJIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 BELLEVUE AVE SUITE 104
TRENTON NJ
08618-4513
US

IV. Provider business mailing address

416 BELLEVUE AVE SUITE 104
TRENTON NJ
08618-4513
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-4700
  • Fax:
Mailing address:
  • Phone: 609-396-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD 071833L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: