MEDICARE: DR. LAUREN DARA GROSSMAN DPM

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	213E00000X	Podiatrist	25MD00310200	NJ

General Provider Information

NPI Number	:	1467757294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN DARA GROSSMAN DPM

Provider Business Mailing Address
First Line	:	10 MCKINLEY ST STE 15
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2726
Country	:	US
Telephone Number	:	201-979-3050
Fax Number	:	469-259-7524

Provider Business Practice Location Address
First Line	:	10 MCKINLEY ST STE 15
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2726
Country	:	US
Telephone Number	:	201-979-3050
Fax Number	:	469-259-7524

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	11/23/2025

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