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General NPI Number Information
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NPI Number | 1487231403
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Entity Type | Individual
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Provider Name | GRANT CORONICA MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 429 RTE 79 STE 1
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City | MORGANVILLE
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State | NJ
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Zip | 07751
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Country | US
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Telephone | 732-263-7970
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Fax | 732-263-7971
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Provider Business Mailing Address
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Address Line | 429 HWY 79
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City | MORGANVILLE
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State | NJ
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Zip | 07751-9800
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Country | US
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Telephone | 732-263-7970
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA12141600
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License Number State | NJ
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