Provider Demographics
NPI:1962507707
Name:GROSSFELD, JODI STEIN (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:STEIN
Last Name:GROSSFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CIVIC CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-499-0100
Mailing Address - Fax:415-499-0290
Practice Address - Street 1:245 E 63RD ST APT 107
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7453
Practice Address - Country:US
Practice Address - Phone:212-980-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284243207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75125OtherLICENSE
CAG75125OtherLICENSE
CA00G751253Medicare PIN