Healthcare Provider Details

I. General information

NPI: 1205747722
Provider Name (Legal Business Name): LOUIS JOHN GRASSO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MAIN ST STE 4
GARDNER MA
01440-3057
US

IV. Provider business mailing address

131 ENTERPRISE RD
JOHNSTOWN NY
12095-3326
US

V. Phone/Fax

Practice location:
  • Phone: 978-632-6883
  • Fax:
Mailing address:
  • Phone: 518-620-4238
  • Fax: 518-620-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHES6621
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: