Basic Information
| Provider Information | |||||||||
| NPI: | 1174702377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEREMY IAN GROSSER, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 DAPPLEGRAY RD | ||||||||
| Address2: | |||||||||
| City: | BELL CANYON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189292259 | ||||||||
| FaxNumber: | 8187005690 | ||||||||
| Practice Location | |||||||||
| Address1: | 7355 TOPANGA CANYON BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913031244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858500 | ||||||||
| FaxNumber: | 8187005690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 09/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | GROSSER | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
| AuthorizedOfficialMiddleName: | IAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189292259 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | A67128 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.