Provider Demographics
NPI:1295823052
Name:GROSSO, RICHARD (DC)
Entity Type:Individual
Prefix:PROF
First Name:RICHARD
Middle Name:
Last Name:GROSSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-746-3135
Mailing Address - Fax:516-746-3709
Practice Address - Street 1:195 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1702
Practice Address - Country:US
Practice Address - Phone:516-746-3135
Practice Address - Fax:516-746-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0069191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1122Other1122