Provider Demographics
NPI:1134209984
Name:GROSSMAN, STEVEN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 5TH AVE
Mailing Address - Street 2:APT 10
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-876-7408
Mailing Address - Fax:212-876-4446
Practice Address - Street 1:1136 5TH AVE
Practice Address - Street 2:APT 10
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-876-7408
Practice Address - Fax:212-876-4446
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0323821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry