Provider Demographics
NPI:1932107554
Name:GRIZZANTI, JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GRIZZANTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1919
Mailing Address - Country:US
Mailing Address - Phone:973-790-4111
Mailing Address - Fax:973-790-4330
Practice Address - Street 1:297 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1919
Practice Address - Country:US
Practice Address - Phone:973-790-4111
Practice Address - Fax:973-790-4330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33971207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K3901OtherHEALTHNET
BS091OtherOXFORD
08492890004OtherCIGNA
NJ1207709Medicaid
2189627OtherAETNA
NJ434388NFYMedicare ID - Type Unspecified
BS091OtherOXFORD