Individual
MS. IVY SALLY GRODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
15 WARREN ST., NEW YORK, NY 10007
(212) 226-7666
(212) 202-7988
Mailing address
11 PARK PLACE, SUITE 1200, NEW YORK, NY 10007
(212) 226-7666
(212) 202-7988
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
274337
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2011
Last updated
11/01/2016
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