Provider Demographics
NPI:1740360486
Name:GRISAFI, PATRICK ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:GRISAFI
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 1:7 HEMION ROAD
Mailing Address - Street 2:PHYSICIANS AND SURGEONS BLDG
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-357-0073
Mailing Address - Fax:845-357-0082
Practice Address - Street 1:7 HEMION ROAD
Practice Address - Street 2:PHYSICIANS AND SURGEONS BLDG
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-357-0073
Practice Address - Fax:845-357-0082
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00630942Medicaid
228533OtherWELLCARE
29381OtherAETNA
RS372OtherOXFORD
NY00630942Medicaid
B17345Medicare UPIN