Healthcare Provider Details

I. General information

NPI: 1952467060
Provider Name (Legal Business Name): DR. ALISSA MICHELLE GRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FRANKLIN BLVD SUITE #102
LONG BEACH NY
11561-4501
US

IV. Provider business mailing address

35 E OLIVE ST
LONG BEACH NY
11561-3506
US

V. Phone/Fax

Practice location:
  • Phone: 516-889-0100
  • Fax: 516-897-2425
Mailing address:
  • Phone: 516-889-0100
  • Fax: 516-897-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number194998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: