Provider Demographics
NPI:1114461431
Name:GRILLO, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PIERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3123
Mailing Address - Country:US
Mailing Address - Phone:732-213-5889
Mailing Address - Fax:
Practice Address - Street 1:325 PIERSON AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3123
Practice Address - Country:US
Practice Address - Phone:732-213-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician