Basic Information
Provider Information | |||||||||
NPI: | 1487668265 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GROSSMAN | ||||||||
FirstName: | BERNARD | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D., F.A.C.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 408 BELLEVUE AVE | ||||||||
Address2: |   | ||||||||
City: | TRENTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 086184502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6093965800 | ||||||||
FaxNumber: | 6093965528 | ||||||||
Practice Location | |||||||||
Address1: | 408 BELLEVUE AVE | ||||||||
Address2: |   | ||||||||
City: | TRENTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 086184502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6093965800 | ||||||||
FaxNumber: | 6093965528 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MA37087 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 0016050 | 01 | NJ | AETNA | OTHER | 2330008 | 05 | NJ |   | MEDICAID | 1014052 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 445113144 | 01 | NJ | UNITED HC/RAILROAD MC | OTHER | 222369868 | 01 | NJ | HORIZON BC/BS OF NJ | OTHER | F17206 | 01 | NJ | HEALTHNET | OTHER | 0083548000 | 01 | NJ | KEYSTONE HEALTH PLANS | OTHER | 1523708 | 01 | NJ | UMWA | OTHER | F17206 | 01 | NJ | GHN | OTHER | 0083548000 | 01 | NJ | AMERIHEALTH | OTHER |