Healthcare Provider Details

I. General information

NPI: 1235180472
Provider Name (Legal Business Name): RONALD GRUZIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 ACADEMY RD
PHILADELPHIA PA
19114-1545
US

IV. Provider business mailing address

2835 TYSON AVE
PHILADELPHIA PA
19149-1415
US

V. Phone/Fax

Practice location:
  • Phone: 215-632-8700
  • Fax: 215-632-7865
Mailing address:
  • Phone: 215-624-6162
  • Fax: 215-624-2732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS007889L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: