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General NPI Number Information
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NPI Number | 1457412876
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Entity Type | Individual
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Provider Name | RONALD STEVEN GRUEN EDD
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1236 BRACE RD STE D
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3229
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Country | US
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Telephone | 856-795-7674
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Fax | 856-795-6622
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Provider Business Mailing Address
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Address Line | 1236 BRACE RD STE D
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3229
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Country | US
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Telephone | 856-795-7674
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Fax | 856-795-6622
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1129
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS001860L
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License Number State | PA
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