Healthcare Provider Details

I. General information

NPI: 1881915833
Provider Name (Legal Business Name): MARTIN SIMON GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

789 HOWARD AVE
NEW HAVEN CT
06519-1304
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2815
  • Fax:
Mailing address:
  • Phone: 203-785-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number17624
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number86191
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: