Provider Demographics
NPI:1205821949
Name:GROSSI, EUGENE A (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:GROSSI
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 1:530 1ST AVE
Mailing Address - Street 2:SUITE 9V
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7452
Mailing Address - Fax:212-263-0147
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 9V
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7452
Practice Address - Fax:212-263-0147
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153862208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01136103Medicaid
NY23F971Medicare ID - Type Unspecified
NY01136103Medicaid