Provider Demographics
NPI:1487668265
Name:GROSSMAN, BERNARD (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4502
Mailing Address - Country:US
Mailing Address - Phone:609-396-5800
Mailing Address - Fax:609-396-5528
Practice Address - Street 1:408 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4502
Practice Address - Country:US
Practice Address - Phone:609-396-5800
Practice Address - Fax:609-396-5528
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37087207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016050OtherAETNA
NJ2330008Medicaid
NJ1014052OtherHORIZON NJ HEALTH
NJ445113144OtherUNITED HC/RAILROAD MC
NJ222369868OtherHORIZON BC/BS OF NJ
NJF17206OtherHEALTHNET
NJ0083548000OtherKEYSTONE HEALTH PLANS
NJ1523708OtherUMWA
NJF17206OtherGHN
NJ0083548000OtherAMERIHEALTH
NJ222369868OtherHORIZON BC/BS OF NJ
NJ143142BL1Medicare ID - Type UnspecifiedMEDICARE ID NUMBER