Provider Demographics
NPI:1194799346
Name:GRELLER, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GRELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 PROFESSIONAL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7904
Mailing Address - Country:US
Mailing Address - Phone:732-720-2555
Mailing Address - Fax:732-720-2556
Practice Address - Street 1:301 PROFESSIONAL VIEW DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7904
Practice Address - Country:US
Practice Address - Phone:732-720-2555
Practice Address - Fax:732-720-2556
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068977207XS0114X
NJMA06897700207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH16223Medicare UPIN