Provider Demographics
NPI:1972527471
Name:HARRY P GROSSMAN DMD PA
Entity Type:Organization
Organization Name:HARRY P GROSSMAN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-297-6111
Mailing Address - Street 1:2864 STATE RT.27
Mailing Address - Street 2:LINCOLN PROFESSIONAL CENTER SUITE B
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:723-297-6111
Mailing Address - Fax:732-297-7177
Practice Address - Street 1:2864 STATE ROUTE 27
Practice Address - Street 2:LINCOLN PROFESSIONAL CENTER SUITE B
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5010
Practice Address - Country:US
Practice Address - Phone:723-297-6111
Practice Address - Fax:732-297-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9146261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental