Provider Demographics
NPI:1164789939
Name:JOHN J GRILLO PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:JOHN J GRILLO PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-693-2619
Mailing Address - Street 1:75 WESTEND AVENUE
Mailing Address - Street 2:APT #P33C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:917-693-2619
Mailing Address - Fax:718-217-2896
Practice Address - Street 1:75 W END AVE APT P37C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7881
Practice Address - Country:US
Practice Address - Phone:917-693-2619
Practice Address - Fax:718-217-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180759207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F73543Medicare UPIN