Healthcare Provider Details

I. General information

NPI: 1891379129
Provider Name (Legal Business Name): DANIEL GROSSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 JONES HOLLOW RD
MARLBOROUGH CT
06447-1448
US

IV. Provider business mailing address

14 JONES HOLLOW RD
MARLBOROUGH CT
06447-1448
US

V. Phone/Fax

Practice location:
  • Phone: 860-295-8217
  • Fax: 860-295-9734
Mailing address:
  • Phone: 860-295-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82948
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: