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General NPI Number Information
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NPI Number | 1124194410
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Entity Type | Individual
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Provider Name | WENDY LYNN GROSSMAN DPM
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 905 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2869
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Country | US
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Telephone | 973-566-0811
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Fax | 973-566-0833
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Provider Business Mailing Address
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Address Line | 905 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2869
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Country | US
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Telephone | 973-566-0811
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Fax | 973-566-0833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 25MD00230300
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License Number State | NJ
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