Provider Demographics
NPI:1609810449
Name:GIANGRASSO, THOMAS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:GIANGRASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-584-1391
Mailing Address - Fax:973-584-7017
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:SUITE 207
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-584-1391
Practice Address - Fax:973-584-7017
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03930900207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3039706Medicaid
NJC55679Medicare UPIN
NJ3039706Medicaid