Healthcare Provider Details

I. General information

NPI: 1134209984
Provider Name (Legal Business Name): STEVEN ROBERT GROSSMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 5TH AVE APT 10
NEW YORK NY
10128
US

IV. Provider business mailing address

1136 5TH AVE APT 10
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-7408
  • Fax: 212-876-4446
Mailing address:
  • Phone: 212-876-7408
  • Fax: 212-876-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number032382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: