Provider Demographics
NPI:1558537233
Name:LEONARD J. GROSSMAN. MD
Entity Type:Organization
Organization Name:LEONARD J. GROSSMAN. MD
Other - Org Name:PEDIATRIC & ADOLESCENT CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-347-8500
Mailing Address - Street 1:1911 ROUTE 46
Mailing Address - Street 2:P O BOX 500
Mailing Address - City:NETCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07857-0500
Mailing Address - Country:US
Mailing Address - Phone:973-347-8500
Mailing Address - Fax:973-347-7320
Practice Address - Street 1:1911 ROUTE 46
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852
Practice Address - Country:US
Practice Address - Phone:973-347-8500
Practice Address - Fax:973-347-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02924700302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization