Provider Demographics
NPI:1194991729
Name:WAYNE A. GROSNICK & ASSOCIATES, P.A.
Entity type:Organization
Organization Name:WAYNE A. GROSNICK & ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GROSNICK
Authorized Official - Suffix:
Authorized Official - Credentials:CAP
Authorized Official - Phone:727-586-6942
Mailing Address - Street 1:13191 STARKEY RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1400
Mailing Address - Country:US
Mailing Address - Phone:727-586-6942
Mailing Address - Fax:727-216-7692
Practice Address - Street 1:13191 STARKEY RD
Practice Address - Street 2:SUITE 14
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1400
Practice Address - Country:US
Practice Address - Phone:727-586-6942
Practice Address - Fax:727-216-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSR-52-AD-823801251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health