Provider Demographics
NPI:1356410500
Name:GROSSMAN, BONNIE D (MD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:D
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 1:321 GENESEE ST
Mailing Address - Street 2:OHC BUSINESS OFFICE
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2611
Mailing Address - Country:US
Mailing Address - Phone:315-361-2047
Mailing Address - Fax:315-361-2191
Practice Address - Street 1:321 GENESEE ST
Practice Address - Street 2:OHC BUSINESS OFFICE
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2611
Practice Address - Country:US
Practice Address - Phone:315-361-2047
Practice Address - Fax:315-361-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146417207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59304Medicare UPIN