Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 26160 | NJ |
NPI | 1437370004 |
---|---|
Provider Name | Surender M Grover |
First Address | South Amboy, NJ 08879 |
Second Address | South Amboy, NJ 08879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2803402 | (05) | NJ |
D07208 | (02) | NJ |