MEDICARE: DR. RONALD JAY GROSSBERG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33219	NY

General Provider Information

NPI Number	:	1083641682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD JAY GROSSBERG D.D.S.

Provider Business Mailing Address
First Line	:	319 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-5501
Country	:	US
Telephone Number	:	718-625-0183
Fax Number	:	718-625-0183

Provider Business Practice Location Address
First Line	:	319 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-5501
Country	:	US
Telephone Number	:	718-625-0183
Fax Number	:	718-625-0183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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