Provider Demographics
NPI:1568723310
Name:BALDUCCI-GRANOZIO D C
Entity Type:Organization
Organization Name:BALDUCCI-GRANOZIO D C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANOZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-450-0086
Mailing Address - Street 1:392 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3251
Mailing Address - Country:US
Mailing Address - Phone:973-450-0086
Mailing Address - Fax:973-450-0086
Practice Address - Street 1:392 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3251
Practice Address - Country:US
Practice Address - Phone:973-450-0086
Practice Address - Fax:973-450-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty