1376618983 NPI number — ELISSA BETH GROSS D.O.

Table of content: ELISSA BETH GROSS D.O. (NPI 1376618983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376618983 NPI number — ELISSA BETH GROSS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS
Provider First Name:
ELISSA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1376618983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BRADHURST AVE
Provider Second Line Business Mailing Address:
CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10532-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-594-3916
Provider Business Mailing Address Fax Number:
914-594-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 BRADHURST AVE
Provider Second Line Business Practice Location Address:
CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10532-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-594-3916
Provider Business Practice Location Address Fax Number:
914-594-3585
Provider Enumeration Date:
11/21/2006

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: 208000000X , with the licence number:  248423 , 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: 03068004 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".