Healthcare Provider Details

I. General information

NPI: 1710917059
Provider Name (Legal Business Name): NEIL S. GROSSMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DEBBIE CT
DIX HILLS NY
11746-5601
US

IV. Provider business mailing address

7 DEBBIE CT
DIX HILLS NY
11746-5601
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-4211
  • Fax:
Mailing address:
  • Phone: 631-271-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003673-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: