Provider Demographics
NPI:1063926475
Name:ROBINSON, GRANT LEE SR
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:LEE
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GRANT
Other - Middle Name:LEE
Other - Last Name:ROBINSON
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:COO
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-8511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1719
Practice Address - Country:US
Practice Address - Phone:856-364-0544
Practice Address - Fax:856-300-5562
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172A00000XOther Service ProvidersDriver
No374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide