Healthcare Provider Details

I. General information

NPI: 1023262904
Provider Name (Legal Business Name): DENNIS GROSS DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 5TH AVE
NEW YORK NY
10021-4157
US

IV. Provider business mailing address

900 5TH AVE
NEW YORK NY
10021-4157
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-4555
  • Fax: 212-725-0946
Mailing address:
  • Phone: 212-725-4555
  • Fax: 212-725-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number174233
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS F GROSS
Title or Position: OWNER
Credential: MD
Phone: 212-725-4555