Provider Demographics
NPI:1609940881
Name:GROSSMAN, ROBERT S
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GROSSMAN
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 1:45 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1530
Mailing Address - Country:US
Mailing Address - Phone:203-426-0662
Mailing Address - Fax:
Practice Address - Street 1:45 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1530
Practice Address - Country:US
Practice Address - Phone:203-426-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09602174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84472Medicare UPIN