Provider Demographics
NPI:1851477285
Name:BLANCO, GRISCO S (MD)
Entity Type:Individual
Prefix:DR
First Name:GRISCO
Middle Name:S
Last Name:BLANCO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3242 87TH ST
Mailing Address - Street 2:EAST ELMHURST QUEENS
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-2138
Mailing Address - Country:US
Mailing Address - Phone:718-651-4014
Mailing Address - Fax:718-651-4014
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:JAMAICA QUEENS
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-7095
Practice Address - Fax:718-206-7169
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1706072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01845032Medicaid