Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00212100 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00212100 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | 25MD00212100 | NJ |
N | 111NR0200X | Radiology | 25MD00212100 | NJ |
N | 213ER0200X | Radiology | 25MD00212100 | NJ |
N | 2081S0010X | Sports Medicine | 25MD00212100 | NJ |
N | 213ES0000X | Sports Medicine | 25MD00212100 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | 25MD00212100 | NJ |
NPI | 1861555070 |
---|---|
Provider Name | Dr. Steven Michael Grant |
First Address | Sicklerville, NJ 08081-1777 |
Second Address | Sicklerville, NJ 08081-1777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 17/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5198500 | (05) | NJ |
U31299 | (02) | NJ |