Healthcare Provider Details

I. General information

NPI: 1871699686
Provider Name (Legal Business Name): ROBERT H GROZALIS JR. MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 HEACOCK RD SUITE 203
YARDLEY PA
19067
US

IV. Provider business mailing address

680 HEACOCK RD SUITE 203
YARDLEY PA
19067
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-2337
  • Fax: 215-321-2339
Mailing address:
  • Phone: 215-321-2337
  • Fax: 215-321-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT005886
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2342258000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDEPENDENCE BC
# 2
Identifier3573618
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 3
Identifier1011559410001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: