Healthcare Provider Details

I. General information

NPI: 1598845059
Provider Name (Legal Business Name): SUSAN J GROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INSTITUTE FOR WOMEN'S HEALTH 1695 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

10 ALDERBROOK RD
BRONX NY
10471-3206
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8150
  • Fax:
Mailing address:
  • Phone: 718-405-8150
  • Fax: 718-405-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number196057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: