Provider Demographics
NPI:1780838359
Name:GROSMAN, MARINA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:GROSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 BAYFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4624
Mailing Address - Country:US
Mailing Address - Phone:516-318-9832
Mailing Address - Fax:
Practice Address - Street 1:3438 BAYFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4624
Practice Address - Country:US
Practice Address - Phone:516-318-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013998-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist