Provider Demographics
NPI:1972716983
Name:GROSMAN, LUBA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LUBA
Middle Name:
Last Name:GROSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ALBANY ST
Mailing Address - Street 2:APT 8I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1404
Mailing Address - Country:US
Mailing Address - Phone:917-282-4297
Mailing Address - Fax:
Practice Address - Street 1:300 ALBANY ST
Practice Address - Street 2:APT 8I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1404
Practice Address - Country:US
Practice Address - Phone:917-282-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01270021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist