Basic Information
| Provider Information | |||||||||
| NPI: | 1487114880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | YAKOV | ||||||||
| MiddleName: | ARYE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 PARKVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112301111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175867337 | ||||||||
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| Practice Location | |||||||||
| Address1: | SUNY DOWNSTATE MEDICAL CENTER | ||||||||
| Address2: | 450 CLARKSON AVENUE # 59 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182701480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2019 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.