Provider Demographics
NPI:1528026853
Name:GROSSMAN, ANDREW GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GEORGE
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PALM SPRINGS BLVD APT 601
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2652
Mailing Address - Country:US
Mailing Address - Phone:973-886-0045
Mailing Address - Fax:888-453-1715
Practice Address - Street 1:500 PALM SPRINGS BLVD APT 601
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2652
Practice Address - Country:US
Practice Address - Phone:973-886-0045
Practice Address - Fax:888-453-1715
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0838705Medicaid
NJ597427Medicare ID - Type Unspecified
NJ0838705Medicaid