Provider Demographics
NPI:1760448609
Name:TOMASZ GROCHOWALSKI MD PA
Entity type:Organization
Organization Name:TOMASZ GROCHOWALSKI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROCHOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-721-5511
Mailing Address - Street 1:2045 STATE ROUTE 35
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2069
Mailing Address - Country:US
Mailing Address - Phone:732-721-5511
Mailing Address - Fax:732-721-2007
Practice Address - Street 1:2045 STATE ROUTE 35
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2069
Practice Address - Country:US
Practice Address - Phone:732-721-5511
Practice Address - Fax:732-721-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2590012OtherGHI
NJ4986761OtherCIGNA
NJP3000218OtherOXFORD
NJ3214640OtherAETNA
NJP3000218OtherOXFORD
NJG67273Medicare UPIN