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General NPI Number Information
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NPI Number | 1972543098
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Entity Type | Individual
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Provider Name | MARC GROSSMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 12 GREENRIDGE AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1238
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Country | US
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Telephone | 914-946-1101
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Fax | 914-946-6925
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Provider Business Mailing Address
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Address Line | 12 GREENRIDGE AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1238
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Country | US
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Telephone | 914-946-1101
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Fax | 914-946-5925
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 127577
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License Number State | NY
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