1851477285 NPI number — DR. GRISCO S BLANCO M.D.

Table of content: DR. GRISCO S BLANCO M.D. (NPI 1851477285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851477285 NPI number — DR. GRISCO S BLANCO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCO
Provider First Name:
GRISCO
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851477285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3242 87TH ST
Provider Second Line Business Mailing Address:
EAST ELMHURST QUEENS
Provider Business Mailing Address City Name:
EAST ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11369-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-651-4014
Provider Business Mailing Address Fax Number:
718-651-4014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 VAN WYCK EXPY
Provider Second Line Business Practice Location Address:
JAMAICA QUEENS
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11418-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-206-7095
Provider Business Practice Location Address Fax Number:
718-206-7169
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  170607 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01845032 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com