Healthcare Provider Details

I. General information

NPI: 1891628855
Provider Name (Legal Business Name): HADASSAH GROSSMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EASTVIEW DR
CENTRAL ISLIP NY
11722-4539
US

IV. Provider business mailing address

1269 47TH ST
BROOKLYN NY
11219-2502
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1251103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: