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General NPI Number Information
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NPI Number | 1356527998
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Entity Type | Organization
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Legal Business Name | NAOMI S GROBSTEIN
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 48 FAIRFIELD ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4137
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Country | US
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Telephone | 973-744-8511
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Fax | 973-744-6356
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Provider Business Mailing Address
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Address Line | 48 FAIRFIELD ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4137
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Country | US
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Telephone | 973-744-8511
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Fax | 973-744-6356
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DEBORAH TICKE
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Credential |
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Telephone | 973-744-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA03933400
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License Number State | NJ
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