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General NPI Number Information
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NPI Number | 1407885072
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Entity Type | Individual
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Provider Name | DEBRA ANN GROSSANO RD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 725 RIVER RD SUITE 106
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-615-9139
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Fax | 866-391-3047
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Provider Business Mailing Address
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Address Line | 446 RADCLIFFE ST
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City | WYCKOFF
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State | NJ
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Zip | 07481-3062
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Country | US
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Telephone | 201-615-9139
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Fax | 866-391-3047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 005443
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License Number State | NY
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