Provider Demographics
NPI:1568486249
Name:GROSSO, DOMINICK A (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:A
Last Name:GROSSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GLOBE CT
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1824
Mailing Address - Country:US
Mailing Address - Phone:732-219-0110
Mailing Address - Fax:732-212-8818
Practice Address - Street 1:5 GLOBE CT
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1824
Practice Address - Country:US
Practice Address - Phone:732-219-0110
Practice Address - Fax:732-212-8818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04501200207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine