Provider Demographics
NPI:1326096983
Name:GRILLO, ANTHONY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:GRILLO
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 1:2900 HEMPSTEAD TPKE
Mailing Address - Street 2:SIUTE 205
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1404
Mailing Address - Country:US
Mailing Address - Phone:516-735-7181
Mailing Address - Fax:631-692-8680
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:SIUTE 205
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-735-7181
Practice Address - Fax:631-692-8680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169653208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01835670Medicaid
NYA59863Medicare UPIN