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General NPI Number Information
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NPI Number | 1427012533
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Entity Type | Individual
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Provider Name | KENNETH A GROSSMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 180 WHITE RD SUITE 103
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1166
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Country | US
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Telephone | 732-842-5222
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Fax | 732-741-6285
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Provider Business Mailing Address
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Address Line | 180 WHITE RD SUITE 103
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1166
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Country | US
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Telephone | 732-842-5222
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Fax | 732-741-6285
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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 | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 25MA04207000
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License Number State | NJ
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