Provider Demographics
NPI:1104368786
Name:GROSSMAN, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 86TH ST
Mailing Address - Street 2:6CE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4714
Mailing Address - Country:US
Mailing Address - Phone:561-213-8703
Mailing Address - Fax:
Practice Address - Street 1:315 E 86TH ST
Practice Address - Street 2:6CE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4714
Practice Address - Country:US
Practice Address - Phone:561-213-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse