MEDICARE: DR. ELLIOT A. GROSSMAN M.D.

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	208600000X	Surgery Physician	138492	NY

General Provider Information

NPI Number	:	1336223916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT A. GROSSMAN M.D.

Provider Business Mailing Address
First Line	:	1097 OLD COUNTRY RD
Second Line	:	SUITE 101
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-6505
Country	:	US
Telephone Number	:	516-935-1821
Fax Number	:	516-935-2823

Provider Business Practice Location Address
First Line	:	1097 OLD COUNTRY RD
Second Line	:	SUITE 101
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-6505
Country	:	US
Telephone Number	:	516-935-1821
Fax Number	:	516-935-2823

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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