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General NPI Number Information
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NPI Number | 1861555070
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Entity Type | Individual
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Provider Name | STEVEN MICHAEL GRANT DPM
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 485 WILLIAMSTOWN RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1777
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Country | US
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Telephone | 856-237-8080
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Fax | 856-740-0367
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Provider Business Mailing Address
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Address Line | 485 WILLIAMSTOWN RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1777
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Country | US
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Telephone | 856-237-8080
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Fax | 856-740-0367
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00212100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 25MD00212100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | 25MD00212100
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 25MD00212100
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00212100
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License Number State | NJ
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