Provider Demographics
NPI:1982367439
Name:GROSSMAN, MICHELLE A (RDMS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HUDSON POINTE DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3938
Mailing Address - Country:US
Mailing Address - Phone:845-464-0099
Mailing Address - Fax:
Practice Address - Street 1:1110 ROUTE 55
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5045
Practice Address - Country:US
Practice Address - Phone:845-473-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies