Healthcare Provider Details

I. General information

NPI: 1639527526
Provider Name (Legal Business Name): GRG MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 NICOLE DR
SOUTHAMPTON PA
18966-3638
US

IV. Provider business mailing address

618 NICOLE DR
SOUTHAMPTON PA
18966-3638
US

V. Phone/Fax

Practice location:
  • Phone: 215-742-7300
  • Fax: 215-725-2072
Mailing address:
  • Phone: 215-742-7300
  • Fax: 215-725-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD R GOLDSMAN
Title or Position: PRESIDENT
Credential:
Phone: 215-742-7300