Provider Demographics
NPI:1316912884
Name:GROB, PATRICIO (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICIO
Middle Name:
Last Name:GROB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 S JEFFERSON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1029
Mailing Address - Country:US
Mailing Address - Phone:973-599-9779
Mailing Address - Fax:973-599-1179
Practice Address - Street 1:91 S JEFFERSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1029
Practice Address - Country:US
Practice Address - Phone:973-599-9779
Practice Address - Fax:973-599-1179
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07769200207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084094Medicare ID - Type Unspecified
NJH53543Medicare UPIN