Basic Information
Provider Information
NPI: 1073514105
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRUBER
FirstName: GABRIEL
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 DIAMOND HILL RD
Address2: SUMMIT MEDICAL GROUP
City: BERKELEY HEIGHTS
State: NJ
PostalCode: 079222104
CountryCode: US
TelephoneNumber: 9082734300
FaxNumber: 9082778629
Practice Location
Address1: 1 DIAMOND HILL RD
Address2: SUMMIT MEDICAL GROUP
City: BERKELEY HEIGHTS
State: NJ
PostalCode: 079222104
CountryCode: US
TelephoneNumber: 9082734300
FaxNumber: 9082778629
Other Information
ProviderEnumerationDate: 08/10/2005
LastUpdateDate: 04/02/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XMA38831NJY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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