Provider Demographics
NPI:1619989456
Name:GROSSO, JOSEPH XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:XAVIER
Last Name:GROSSO
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 1:1 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8114
Mailing Address - Country:US
Mailing Address - Phone:201-391-4141
Mailing Address - Fax:
Practice Address - Street 1:1 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8114
Practice Address - Country:US
Practice Address - Phone:201-391-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2195909Medicaid
NJ2195909Medicaid
NJGR456702Medicare ID - Type Unspecified