Healthcare Provider Details

I. General information

NPI: 1588660021
Provider Name (Legal Business Name): JAY S GROSSMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 OLD YORK RD NORTH COURT
JENKINTOWN PA
19046-2882
US

IV. Provider business mailing address

678 OLD YORK RD NORTH COURT
JENKINTOWN PA
19046-2882
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-4733
  • Fax:
Mailing address:
  • Phone: 215-885-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS002853L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: