=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912019332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELVIN SAUL GRUBER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 01/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 ROUTE 168 SUITE F-6
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-227-7488
-----------------------------------------------------
Fax | 856-228-3476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 ROUTE 168 SUITE F-6
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-227-7488
-----------------------------------------------------
Fax | 856-228-3476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 25MA02362400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MD009679E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------