Provider Demographics
NPI:1730500448
Name:GROSSBAUM, BARRY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:GROSSBAUM
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4104
Mailing Address - Country:US
Mailing Address - Phone:914-472-8900
Mailing Address - Fax:914-472-8901
Practice Address - Street 1:10 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4104
Practice Address - Country:US
Practice Address - Phone:914-472-8900
Practice Address - Fax:914-472-8901
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004544-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician