| Organization Name: | DOMINICK A. GROSSO, D.O. LLC |
| NPI Number: | 1063436749 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOMINICK A. GROSSO (PHYSICIAN/OWNER) |
| Mailing Address: | 5 Globe Ct Red Bank |
| State: | NJ US |
| Postal Code: | 077011824 |
| Phone Number: | 7322190110 |
| Fax Number: | 7322128818 |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 08/22/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 25MB04501200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |