Provider Demographics
NPI:1861745820
Name:GROEBER, STEPHANIE MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:GROEBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PRINCESS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2320
Mailing Address - Country:US
Mailing Address - Phone:609-896-0777
Mailing Address - Fax:609-896-3266
Practice Address - Street 1:2 PRINCESS RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2320
Practice Address - Country:US
Practice Address - Phone:609-896-0777
Practice Address - Fax:609-896-3266
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00295600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ257832YH14Medicare PIN