Organization
DOMINICK A. GROSSO, D.O. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINICK A. GROSSO D.O. (PHYSICIAN/OWNER)
(732) 219-0110
Entity
Organization
Contact information
Practice address
5 GLOBE CT, RED BANK, NJ 07701-1824
(732) 219-0110
(732) 212-8818
Mailing address
5 GLOBE CT, RED BANK, NJ 07701-1824
(732) 219-0110
(732) 212-8818
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
25MB04501200
NJ
207R00000X
Internal Medicine Physician
Primary
25MB04501200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1485601
—
NJ
01
—
2599954
GHI
NJ
Enumeration date
07/27/2006
Last updated
08/22/2007
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