Provider Demographics
NPI:1487788758
Name:GRASSO, SANTO VINCENT (DO)
Entity type:Individual
Prefix:DR
First Name:SANTO
Middle Name:VINCENT
Last Name:GRASSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1155
Mailing Address - Country:US
Mailing Address - Phone:973-239-1699
Mailing Address - Fax:973-239-1692
Practice Address - Street 1:1027 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1155
Practice Address - Country:US
Practice Address - Phone:973-239-1699
Practice Address - Fax:973-239-1692
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB68666208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG89534Medicare UPIN