Healthcare Provider Details

I. General information

NPI: 1376618983
Provider Name (Legal Business Name): ELISSA BETH GROSS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
HAWTHORNE NY
10532-0000
US

IV. Provider business mailing address

19 BRADHURST AVE CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER
HAWTHORNE NY
10532-0000
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-3916
  • Fax: 914-594-3585
Mailing address:
  • Phone: 914-594-3916
  • Fax: 914-594-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: