Provider Demographics
NPI:1073777165
Name:GRASSO, ELIZABETH CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:GRASSO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EXCHANGE PL
Mailing Address - Street 2:APT 4207
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3201
Mailing Address - Country:US
Mailing Address - Phone:781-548-9108
Mailing Address - Fax:
Practice Address - Street 1:20 EXCHANGE PL
Practice Address - Street 2:APT 4207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3201
Practice Address - Country:US
Practice Address - Phone:781-548-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant