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NPI Code Detail

MEDICARE: DR. IGOR GROSMAN D.O.

MEDICARE:  DR. IGOR  GROSMAN  D.O.
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
1207R00000XInternal Medicine Physician239458NY
2207RG0100XGastroenterology Physician239458NY

General Provider Information

NPI Number : 1851506869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IGOR GROSMAN D.O.
Provider Business Mailing Address
First Line : 2676 E 65TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-6824
Country : US
Telephone Number : 646-207-4933
Fax Number :
Provider Business Practice Location Address
First Line : 2015 SHORE PKWY APT 16J
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-6869
Country : US
Telephone Number : 646-207-4933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2007
Last Update Date : 04/20/2011

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Directions to “ DR. IGOR GROSMAN D.O.” Practice Location

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