Healthcare Provider Details

I. General information

NPI: 1902028863
Provider Name (Legal Business Name): CAREY ELLEN GROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 ENGLE STREET
TENAFLY NJ
07670
US

IV. Provider business mailing address

260 ENGLE STREET
TENAFLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-6000
  • Fax:
Mailing address:
  • Phone: 201-567-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number25MA05746800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: