Active NPI
Edwina Grossman
- Licensed Practical Nurse
- Liverpool, NY
National Provider Identifier
1003024266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 239995-1
- Practice address
- 7471 Buckeye Rd
Liverpool, NY 13088-4111 - Phone
- (315) 453-3696
- NPI assigned
- May 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 239995-1 | NY | Primary |
Addresses
Primary practice location
7471 Buckeye Rd
Liverpool, NY 13088-4111
Mailing address
45 Potter Rd
West Monroe, NY 13167-4136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CX80272R | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 239995-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003024266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 POTTER RD",
"city": "WEST MONROE",
"state": "NY",
"postal_code": "131674136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7471 BUCKEYE RD",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130884111",
"telephone_number": "315-453-3696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSMAN",
"first_name": "EDWINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "239995-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CX80272R",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.