Healthcare Provider Details

I. General information

NPI: 1063972107
Provider Name (Legal Business Name): ROSS FIRESTONE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

IV. Provider business mailing address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

V. Phone/Fax

Practice location:
  • Phone: 201-775-7000
  • Fax:
Mailing address:
  • Phone: 201-775-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number307320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: