Provider Demographics
NPI:1306115589
Name:GROSSMAN, JUDITH E (OTR)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:25 WEST 68TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5302
Mailing Address - Country:US
Mailing Address - Phone:646-505-0356
Mailing Address - Fax:
Practice Address - Street 1:149 EAST 78TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0405
Practice Address - Country:US
Practice Address - Phone:212-879-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001357-1172V00000X, 225X00000X, 106H00000X
CT002216172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist