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General NPI Number Information
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NPI Number | 1609820372
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Entity Type | Individual
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Provider Name | IRINA GROSMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 4725 N FEDERAL HWY HOLY CROSS HOSPITAL DEPARTMENT OF RADIATION
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4603
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Country | US
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Telephone | 954-492-5764
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Fax | 954-776-3238
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Provider Business Mailing Address
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Address Line | 405 N OCEAN BLVD APT 1501
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City | POMPANO BEACH
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State | FL
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Zip | 33062-5153
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Country | US
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Telephone | 347-400-0405
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Fax | 954-785-3142
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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 | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | ME 71096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 25MA06449800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 196838-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | MD058312L
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License Number State | PA
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