Provider Demographics
NPI:1215004387
Name:GROSSINGER, LARRY JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAY
Last Name:GROSSINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SPRUCE STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1400
Mailing Address - Country:US
Mailing Address - Phone:570-342-7814
Mailing Address - Fax:
Practice Address - Street 1:321 SPRUCE STREET
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1400
Practice Address - Country:US
Practice Address - Phone:570-342-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001383L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR48686OtherBCBS
T27589Medicare UPIN
PAGR48686Medicare ID - Type Unspecified