Healthcare Provider Details

I. General information

NPI: 1932362936
Provider Name (Legal Business Name): BARBARA E LEE-GRASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR STE 320
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

PO BOX 23831
NEWARK NJ
07189-0831
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-4900
  • Fax: 614-345-1655
Mailing address:
  • Phone: 973-971-7184
  • Fax: 973-290-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN08050200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: