Provider Demographics
NPI:1215227962
Name:GROTTICELLI, JANET (DO)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:GROTTICELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CREST RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1508
Mailing Address - Country:US
Mailing Address - Phone:201-805-4464
Mailing Address - Fax:201-760-0195
Practice Address - Street 1:14 CREST RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1508
Practice Address - Country:US
Practice Address - Phone:201-805-4464
Practice Address - Fax:201-760-0195
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187746207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology