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General NPI Number Information
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NPI Number | 1265714331
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Entity Type | Organization
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Legal Business Name | GROVE ENTERPRISES
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 2001 LINCOLN DR W STE A
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City | MARLTON
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State | NJ
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Zip | 08053-1531
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Country | US
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Telephone | 856-577-0332
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Fax | 856-396-5534
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Provider Business Mailing Address
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Address Line | PO BOX 533
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City | MOORESTOWN
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State | NJ
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Zip | 08057-0533
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Country | US
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Telephone | 856-663-3000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. C MARLO BAIRD
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Credential | MD
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Telephone | 856-577-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | NJ
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