Provider Demographics
NPI:1598985343
Name:GROSSMARK, ROBERT SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:GROSSMARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CENTRAL PARK W APT 1A
Mailing Address - Street 2:SUITE # 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4544
Mailing Address - Country:US
Mailing Address - Phone:212-496-1591
Mailing Address - Fax:
Practice Address - Street 1:241 CENTRAL PARK W APT 1A
Practice Address - Street 2:SUITE # 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4544
Practice Address - Country:US
Practice Address - Phone:212-496-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010308102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097047Medicaid
NYV9A501Medicare ID - Type Unspecified