Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X006396 | NY |
NPI | 1114024270 |
---|---|
Provider Name | Dr. Bradley Grossman |
First Address | New York, NY 10011-2156 |
Second Address | New York, NY 10011-2156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U18145 | (02) |