Provider Demographics
NPI:1306058086
Name:MARCELLE A GRASSI,M.D.P.C.
Entity type:Organization
Organization Name:MARCELLE A GRASSI,M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-651-0726
Mailing Address - Street 1:2560 WALDEN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4757
Mailing Address - Country:US
Mailing Address - Phone:716-561-0726
Mailing Address - Fax:716-651-0729
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-561-0726
Practice Address - Fax:716-651-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC66453Medicare UPIN