Provider Demographics
NPI:1689780819
Name:GRELLA, ROCCO D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:D
Last Name:GRELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:602 IVY ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1646
Practice Address - Country:US
Practice Address - Phone:607-739-1529
Practice Address - Fax:607-739-1378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1806731207RC0000X
NY180673207RI0011X
PAMD444814207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102239429Medicaid
NY01497947Medicaid
NY01497947Medicaid
PA268725YHLYMedicare PIN
NYJ400066928Medicare PIN