Individual
MALLORY GROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-2000
Mailing address
515 WEST AVE PH 38, NORWALK, CT 06850-4051
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
4368
CT
Other
Enumeration date
12/20/2018
Last updated
03/03/2021
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