Provider Demographics
NPI:1285997916
Name:GROSSMAN, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLFAX RD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 COLFAX RD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2312
Practice Address - Country:US
Practice Address - Phone:609-658-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency