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General NPI Number Information
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NPI Number | 1124153028
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Entity Type | Individual
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Provider Name | STEPHEN A GROCHMAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 29 THE CRES
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2674
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Country | US
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Telephone | 201-696-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 33 E MIDLAND AVE # 1307
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City | PARAMUS
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State | NJ
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Zip | 07652-2916
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Country | US
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Telephone | 201-450-8673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA03884200
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License Number State | NJ
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