Provider Demographics
NPI:1407885072
Name:GROSSANO, DEBRA ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:GROSSANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:446 RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3062
Mailing Address - Country:US
Mailing Address - Phone:201-615-9139
Mailing Address - Fax:866-391-3047
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-615-9139
Practice Address - Fax:866-391-3047
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2220176OtherUNITED
NY3C6516OtherHEALTHNET
NYGD5443OtherATLANTIS
NYP2679923OtherOXFORD
NY132845837OtherMULTIPLAN
NY7380369OtherAETNA
NY8000237OtherGHI
NY132845837OtherPHCS
NY9074E1OtherBLUECROSS
NY132845837OtherBEECHSTREET
NY8672922003OtherCIGNA
NY005443OtherHIP
NY132845837OtherHORIZON
NY2951435OtherUSHC