MEDICARE: LISAMARIE GROSSO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	678733	NY
2	163WI0500X	Infusion Therapy Registered Nurse	678733	NY

General Provider Information

NPI Number	:	1174489256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISAMARIE GROSSO RN

Provider Business Mailing Address
First Line	:	59 RONDOUT HBR
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-5003
Country	:	US
Telephone Number	:	646-729-9938
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 RONDOUT HBR
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-5003
Country	:	US
Telephone Number	:	646-729-9938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2026
Last Update Date	:	01/01/2026

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