Provider Demographics
NPI:1720114853
Name:GROSSMAN, RONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:240 CENTRAL S PARK 2R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1435
Mailing Address - Country:US
Mailing Address - Phone:212-818-0853
Mailing Address - Fax:212-265-0214
Practice Address - Street 1:240 CENTRAL S PARK 2R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1435
Practice Address - Country:US
Practice Address - Phone:212-818-0853
Practice Address - Fax:212-265-0217
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2015-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY105739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY537181Medicare ID - Type Unspecified
NYC11080Medicare UPIN