Provider Demographics
NPI:1609808393
Name:GRASSO, CONO M (MD)
Entity Type:Individual
Prefix:
First Name:CONO
Middle Name:M
Last Name:GRASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83-05 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4104
Mailing Address - Country:US
Mailing Address - Phone:718-429-0300
Mailing Address - Fax:718-899-6338
Practice Address - Street 1:8305 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4104
Practice Address - Country:US
Practice Address - Phone:718-429-0300
Practice Address - Fax:718-899-6338
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124324207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00305046Medicaid
NY00305046Medicaid
NYB87284Medicare UPIN
NY05935QMedicare ID - Type Unspecified