Provider Demographics
NPI:1316053960
Name:GROSSMAN, PHILIP E (DC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:E
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-890-2222
Mailing Address - Fax:609-890-0715
Practice Address - Street 1:2103 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-890-2222
Practice Address - Fax:609-890-0715
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00174200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ458947R50Medicare ID - Type Unspecified
T72991Medicare UPIN