Healthcare Provider Details

I. General information

NPI: 1467402909
Provider Name (Legal Business Name): ANDREW W GROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACHLEY RD
STAMFORD CT
06902
US

IV. Provider business mailing address

PO BOX 29234
NEW YORK NY
10087-2140
US

V. Phone/Fax

Practice location:
  • Phone: 203-705-0935
  • Fax:
Mailing address:
  • Phone: 203-705-0935
  • Fax: 203-705-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number232793
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number232793
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number232793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: