Provider Demographics
NPI:1467164111
Name:GROSSARTH, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GROSSARTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3611
Mailing Address - Country:US
Mailing Address - Phone:347-200-0692
Mailing Address - Fax:
Practice Address - Street 1:2571 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3515
Practice Address - Country:US
Practice Address - Phone:929-371-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency