Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 25MA08786900 | NJ |
N | 208000000X | Pediatrician | ME102782 | FL |
NPI | 1205151115 |
---|---|
Provider Name | Dr. Sandra Grossman |
First Address | Rockland, DE 19732-0191 |
Second Address | Bryn Mawr, PA 19010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA08786900 | SATE LICENSE (01) | NJ |