Provider Demographics
NPI:1871699686
Name:GROZALIS, ROBERT H JR (MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:GROZALIS
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 HEACOCK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-321-2337
Mailing Address - Fax:215-321-2339
Practice Address - Street 1:680 HEACOCK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-321-2337
Practice Address - Fax:215-321-2339
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005886231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2342258000OtherINDEPENDENCE BC
PA3573618OtherAETNA
PA1011559410001Medicaid
PA2342258000OtherINDEPENDENCE BC