Provider Demographics
NPI:1548542137
Name:GROSSO, JAYNE LYDIA (RN)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:LYDIA
Last Name:GROSSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LIDO PKWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6018
Mailing Address - Country:US
Mailing Address - Phone:631-957-1948
Mailing Address - Fax:
Practice Address - Street 1:7 LIDO PKWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6018
Practice Address - Country:US
Practice Address - Phone:631-957-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477849-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse