Provider Demographics
NPI:1609939537
Name:GROSSO, ALBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:E
Last Name:GROSSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2811
Mailing Address - Country:US
Mailing Address - Phone:732-738-1666
Mailing Address - Fax:732-738-8132
Practice Address - Street 1:940 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2811
Practice Address - Country:US
Practice Address - Phone:732-738-1666
Practice Address - Fax:732-738-8132
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5655609Medicaid
NJ5655609Medicaid
NJ630924YDX9Medicare PIN