Active NPI
Michele Grodberg, M.D.
- Dermatology Physician
- Englewood, NJ
National Provider Identifier
1225047038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 25MA05620200
- Practice address
- 106 Grand Ave
Englewood, NJ 07631-3574 - Phone
- (201) 567-8884
- Fax
- (201) 567-5799
- NPI assigned
- Aug 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 25MA05620200 | NJ | Primary |
Addresses
Primary practice location
106 Grand Ave
Englewood, NJ 07631-3574
Mailing address
106 Grand Ave
Englewood, NJ 07631-3574
Phone (201) 567-8884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225047038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 GRAND AVE",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076313574",
"telephone_number": "201-567-8884",
"fax_number": "201-567-5799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 GRAND AVE",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076313574",
"telephone_number": "201-567-8884",
"fax_number": "201-567-5799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRODBERG",
"first_name": "MICHELE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NJ",
"license": "25MA05620200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Englewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.