Individual
MR. REID EDWARD GRONOSTAJSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1140 ROUTE 72 W, MANAHAWKIN, NJ 08050-2412
(609) 978-8900
Mailing address
3219 SCRIMSHAW CT, TOMS RIVER, NJ 08753-6258
(609) 977-5466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00218400
NJ
363AM0700X
Medical Physician Assistant
MA054369
PA
Other
Enumeration date
06/26/2009
Last updated
08/04/2011
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