Provider Demographics
NPI:1568857969
Name:GRASSIA, NICHOLAS (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:GRASSIA
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755
Mailing Address - Country:US
Mailing Address - Phone:732-870-1041
Mailing Address - Fax:
Practice Address - Street 1:61 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-870-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00004800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist