Jack Gruenberg, R. PH.
Individual provider Active NPI Pharmacist · Park Ridge, NJ
NPI 1750600540 · NPPES record last updated May 19, 2010
Key facts
- NPI
- 1750600540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 054468 (NY)
- Practice address
- 27 Fourth Street
Park Ridge, NJ 07656-1902 - Phone
- (201) 248-5207
- NPI assigned
- May 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16429 | NJ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 054468 | NY | Yes |
| Pharmacist | 183500000X | 16429 | NJ |
Addresses
Primary practice location
27 Fourth Street
Park Ridge, NJ 07656-1902
Mailing address
27 Fourth Street
Park Ridge, NJ 07656-1902
Phone (201) 248-5207
Other providers in Park Ridge, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.