Provider Demographics
NPI:1629086814
Name:GROSSMAN, NEIL STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:STEVEN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2039
Mailing Address - Country:US
Mailing Address - Phone:609-261-3884
Mailing Address - Fax:609-261-3884
Practice Address - Street 1:125 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2039
Practice Address - Country:US
Practice Address - Phone:609-261-3884
Practice Address - Fax:609-261-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1025105OtherHORIZON HEALTHCARE/ MERCY