1558537233 NPI number — LEONARD J. GROSSMAN. MD

Table of content: (NPI 1558537233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558537233 NPI number — LEONARD J. GROSSMAN. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD J. GROSSMAN. MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558537233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 ROUTE 46
Provider Second Line Business Mailing Address:
P O BOX 500
Provider Business Mailing Address City Name:
NETCONG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07857-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-347-8500
Provider Business Mailing Address Fax Number:
973-347-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 ROUTE 46
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-347-8500
Provider Business Practice Location Address Fax Number:
973-347-7320
Provider Enumeration Date:
05/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GROSSMAN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
973-347-8500

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  25MA02924700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com