1922360791 NPI number — MRS. JACQUELINE HELEN GROSS MS.E.D.

Table of content: MRS. JACQUELINE HELEN GROSS MS.E.D. (NPI 1922360791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922360791 NPI number — MRS. JACQUELINE HELEN GROSS MS.E.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS
Provider First Name:
JACQUELINE
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS.E.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GROSS
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.E.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922360791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
597 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12182-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-233-0544
Provider Business Mailing Address Fax Number:
518-233-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 125TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12182-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-328-0220
Provider Business Practice Location Address Fax Number:
518-328-0224
Provider Enumeration Date:
06/08/2012

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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