Provider Demographics
NPI:1083748412
Name:GROSSMAN, PAULA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:LYNN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KENT PL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2702
Mailing Address - Country:US
Mailing Address - Phone:516-827-4037
Mailing Address - Fax:
Practice Address - Street 1:4 KENT PL
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2702
Practice Address - Country:US
Practice Address - Phone:516-827-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1319392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45A591Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYC10070Medicare UPIN