Basic Information
Provider Information | |||||||||
NPI: | 1427121631 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GROBSTEIN | ||||||||
FirstName: | NAOMI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24 NORTHVIEW TER | ||||||||
Address2: |   | ||||||||
City: | CEDAR GROVE | ||||||||
State: | NJ | ||||||||
PostalCode: | 070091537 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9732719221 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 930 MARTIN LUTHER KING JR BLVD | ||||||||
Address2: |   | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275142656 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199333301 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/16/2006 | ||||||||
LastUpdateDate: | 06/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA03933400 | NJ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 2021-00105 | NC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 222475272 | 01 | NJ | PHCS | OTHER | 4412567 | 01 | NJ | AETNA TRADITIONAL | OTHER | 411539 | 01 | NJ | CIGNA | OTHER | 002942 | 01 | NJ | AETNA HMO | OTHER | EP117 | 01 | NJ | OXFORD | OTHER | 1K7163 | 01 | NJ | HEALTHNET | OTHER | 516073 | 01 | NJ | UNITED | OTHER | 222475272 | 01 | NJ | HORIZON | OTHER |