Provider Demographics
NPI:1063613404
Name:ROBERT A. GRAEBE, M.D., LLC
Entity type:Organization
Organization Name:ROBERT A. GRAEBE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADM
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-460-1073
Mailing Address - Street 1:1131 BROAD ST
Mailing Address - Street 2:104
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-460-1073
Mailing Address - Fax:732-460-1076
Practice Address - Street 1:1131 BROAD ST
Practice Address - Street 2:104
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-460-1073
Practice Address - Fax:732-460-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03861600207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT024835OtherLICENSE
NY139948-1OtherLICENSE
NJD03159700OtherCDS
NJC-421804Medicaid
NJMA3861600OtherLICENSE
DCAG1554408OtherDEA
NJMA3861600OtherLICENSE
NY139948-1OtherLICENSE