Healthcare Provider Details

I. General information

NPI: 1962561985
Provider Name (Legal Business Name): CELESTE M GROSSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W MARKET ST STE 106
RHINEBECK NY
12572-1413
US

IV. Provider business mailing address

47 W MARKET ST STE 106
RHINEBECK NY
12572-1413
US

V. Phone/Fax

Practice location:
  • Phone: 845-516-5007
  • Fax: 845-516-5009
Mailing address:
  • Phone: 845-516-5007
  • Fax: 845-516-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226456
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number226456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: