Basic Information
| Provider Information | |||||||||
| NPI: | 1063618908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BROWERTOWN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | WOODLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074242671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732835005 | ||||||||
| FaxNumber: | 9738125235 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 BROWERTOWN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | WOODLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074242671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732835005 | ||||||||
| FaxNumber: | 9738125235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 241241 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 25MA08998700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.