Provider Demographics
NPI:1093825721
Name:GRISANTI, JOSEPH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:GRISANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1231
Mailing Address - Country:US
Mailing Address - Phone:716-675-2500
Mailing Address - Fax:716-675-2590
Practice Address - Street 1:3055 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1231
Practice Address - Country:US
Practice Address - Phone:716-675-2500
Practice Address - Fax:716-675-2590
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1652741174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA83203Medicare UPIN