Provider Demographics
NPI:1639119621
Name:GROBMAN, CRAIG R (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:GROBMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2200 NORTHERN BLVD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1219
Mailing Address - Country:US
Mailing Address - Phone:516-352-8100
Mailing Address - Fax:516-352-7348
Practice Address - Street 1:2200 NORTHERN BLVD
Practice Address - Street 2:SUITE 133
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1219
Practice Address - Country:US
Practice Address - Phone:516-352-8100
Practice Address - Fax:516-352-7348
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY172SQ1OtherBLUE CROSS
NY113633426OtherTAX ID
NY138681OtherHIP
NY149ST87631OtherMEDICARE PTAN
NY149ST87631OtherMEDICARE PTAN
NY149ST1Medicare ID - Type Unspecified