Healthcare Provider Details

I. General information

NPI: 1710079546
Provider Name (Legal Business Name): CATHIE CEE GROSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BERGEN PL
FREEPORT NY
11520-3528
US

IV. Provider business mailing address

101 S BERGEN PL
FREEPORT NY
11520-3528
US

V. Phone/Fax

Practice location:
  • Phone: 516-415-7344
  • Fax: 516-415-7345
Mailing address:
  • Phone: 516-415-7344
  • Fax: 516-415-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: