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NPI Code Detail

MEDICARE: EDWARD R GRUBER CN

MEDICARE: EDWARD R GRUBER CN
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
1133N00000XNutritionist001929WA

General Provider Information

NPI Number : 1619203296
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD R GRUBER CN
Provider Business Mailing Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1251
Country : US
Telephone Number : 732-364-2144
Fax Number : 732-364-3559
Provider Business Practice Location Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1251
Country : US
Telephone Number : 732-364-2144
Fax Number : 732-364-3559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2009
Last Update Date : 11/02/2009

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Directions to “ EDWARD R GRUBER CN” Practice Location

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