Provider Demographics
NPI:1689221590
Name:GROSMAN, IGOR
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:GROSMAN
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 1:570 SOUTH AVE E UNIT A
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3200
Mailing Address - Country:US
Mailing Address - Phone:908-272-7990
Mailing Address - Fax:908-272-7970
Practice Address - Street 1:570 SOUTH AVE E UNIT A
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3200
Practice Address - Country:US
Practice Address - Phone:908-272-7990
Practice Address - Fax:908-272-7990
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program