MEDICARE: DR. VADIM GRITSUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA07576600	NJ

General Provider Information

NPI Number	:	1336170182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VADIM GRITSUS M.D.

Provider Business Mailing Address
First Line	:	7 INDUSTRIAL RD
Second Line	:	SUITE 203
City	:	PEQUANNOCK
State	:	NJ
Zip	:	07440-1922
Country	:	US
Telephone Number	:	973-696-9050
Fax Number	:	973-696-9055

Provider Business Practice Location Address
First Line	:	7 INDUSTRIAL RD
Second Line	:	SUITE 203
City	:	PEQUANNOCK
State	:	NJ
Zip	:	07440-1922
Country	:	US
Telephone Number	:	973-696-9050
Fax Number	:	973-696-9055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/15/2008

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