Provider Demographics
NPI:1346221678
Name:GROSMAN, SVETLANA (DO)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:GROSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 AVENUE H STE C1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2294
Mailing Address - Country:US
Mailing Address - Phone:718-253-9110
Mailing Address - Fax:718-253-0676
Practice Address - Street 1:618 AVENUE H STE C1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2294
Practice Address - Country:US
Practice Address - Phone:718-253-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWHA171OtherMEDICARE GROUP NUMBER
NY02187864Medicaid
NY5D5871Medicare ID - Type Unspecified
NY02187864Medicaid