Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 3873 | NY |
N | 152WV0400X | Optomitrist - Vision Therapist | 3873 | NY |
NPI | 1003904988 |
---|---|
Provider Name | Dr. Marc Robert Grossman |
First Address | New Paltz, NY 12561-4017 |
Second Address | New Paltz, NY 12561-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |