Healthcare Provider Details

I. General information

NPI: 1942377023
Provider Name (Legal Business Name): HARVEY R. GROSS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 GRAND AVE SUITE 102
ENGLEWOOD NJ
07631-4154
US

IV. Provider business mailing address

370 GRAND AVE SUITE 102
ENGLEWOOD NJ
07631-4154
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-3370
  • Fax: 201-816-1265
Mailing address:
  • Phone: 201-567-3370
  • Fax: 201-816-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARVEY R GROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 201-567-3370