Provider Demographics
NPI:1972364768
Name:GROLLI, ALISON R
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:GROLLI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BOILING SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1430
Mailing Address - Country:US
Mailing Address - Phone:201-637-2108
Mailing Address - Fax:
Practice Address - Street 1:186 PATERSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1837
Practice Address - Country:US
Practice Address - Phone:201-549-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14966500363LF0000X
NYF352754-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily