Provider Demographics
NPI:1710613823
Name:GROSSMAN, NAZARETH ROXIREE
Entity Type:Individual
Prefix:
First Name:NAZARETH
Middle Name:ROXIREE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WESTBOURNE DRIVE APT 16
Mailing Address - Street 2:
Mailing Address - City:WOODBOURNE
Mailing Address - State:NY
Mailing Address - Zip Code:12788
Mailing Address - Country:US
Mailing Address - Phone:845-645-8093
Mailing Address - Fax:
Practice Address - Street 1:35 WESTBOURNE DRIVE APT 16
Practice Address - Street 2:
Practice Address - City:WOODBOURNE
Practice Address - State:NY
Practice Address - Zip Code:12788
Practice Address - Country:US
Practice Address - Phone:845-645-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)