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General NPI Number Information
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NPI Number | 1780772889
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Entity Type | Organization
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Legal Business Name | ATLANTIC COLON & RECTAL SURGEONS
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 33 OVERLOOK RD SUITE 412
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-598-0220
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Fax | 908-598-0415
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Provider Business Mailing Address
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Address Line | 33 OVERLOOK RD SUITE 412
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-598-0220
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Fax | 908-598-0415
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Authorized Official
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Title or Position | PRES.
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Name | DR. WALTER L. GROFF
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Credential | M.D.
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Telephone | 908-598-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | MA36009
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License Number State | NJ
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