Healthcare Provider Details

I. General information

NPI: 1487788758
Provider Name (Legal Business Name): SANTO VINCENT GRASSO JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RIDGE RD
RUTHERFORD NJ
07070-2422
US

IV. Provider business mailing address

102 RIDGE RD
RUTHERFORD NJ
07070-2422
US

V. Phone/Fax

Practice location:
  • Phone: 201-725-2129
  • Fax:
Mailing address:
  • Phone: 201-725-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06866600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: