Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 239545 | NY |
N | 207VE0102X | Reproductive Endocrinologist | 38293 | KY |
NPI | 1467455816 |
---|---|
Provider Name | Dr. Michael Paul Grossman |
First Address | Niskayuna, NY 12309-2517 |
Second Address | Latham, NY 12110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H90057 | (02) | KY |