Individual
AMY COOPER GROSSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4 OAKDALE LN, ROSLYN HEIGHTS, NY 11577-1535
(516) 621-8330
Mailing address
4 OAKDALE LN, ROSLYN HEIGHTS, NY 11577-1535
(516) 621-8330
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
27T0000A1300
NJ
152W00000X
Optometrist
Primary
T005267
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01296506
—
NY
05
—
5660009
—
NJ
Enumeration date
01/03/2007
Last updated
05/04/2016
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