Provider Demographics
NPI:1528047552
Name:DEAN-GROSACK, NANCY JANE (DPM)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:DEAN-GROSACK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421
Mailing Address - Country:US
Mailing Address - Phone:315-363-2700
Mailing Address - Fax:315-363-1971
Practice Address - Street 1:264 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421
Practice Address - Country:US
Practice Address - Phone:315-363-2700
Practice Address - Fax:315-363-1971
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003230213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00652800Medicaid
NY56802AMedicare PIN
NY4054410001Medicare NSC
T51025Medicare UPIN
NY00652800Medicaid