Provider Demographics
NPI:1346046059
Name:GROOMS, DAMIEN JERMAINE
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:JERMAINE
Last Name:GROOMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 GOULDTOWN WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-7244
Mailing Address - Country:US
Mailing Address - Phone:856-776-1403
Mailing Address - Fax:
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1702
Practice Address - Country:US
Practice Address - Phone:856-256-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer