Provider Demographics
NPI:1255780086
Name:GROSSMAN, JAMIE (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GROSSMAN
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 1:300 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6303
Mailing Address - Country:US
Mailing Address - Phone:732-923-5400
Mailing Address - Fax:732-923-5404
Practice Address - Street 1:1760 OLD MEADOW ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4306
Practice Address - Country:US
Practice Address - Phone:703-810-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101275088207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program