Provider Demographics
NPI:1922054709
Name:GROSSMAN, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CROSSWAYS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2002
Mailing Address - Country:US
Mailing Address - Phone:516-992-5230
Mailing Address - Fax:516-938-3239
Practice Address - Street 1:43 CROSSWAYS PARK DR W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2002
Practice Address - Country:US
Practice Address - Phone:516-992-5230
Practice Address - Fax:516-938-3239
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128011207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00867661Medicaid
NYC07866Medicare UPIN
NY29A551Medicare ID - Type Unspecified