Provider Demographics
NPI:1740432327
Name:GROSSMAN, STANLEY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LAWRENCE
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:LAWRENCE
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:82 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1409
Mailing Address - Country:US
Mailing Address - Phone:845-562-2067
Mailing Address - Fax:845-562-3870
Practice Address - Street 1:82 SUSAN DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1409
Practice Address - Country:US
Practice Address - Phone:845-562-2067
Practice Address - Fax:845-562-3870
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076733-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery