Healthcare Provider Details

I. General information

NPI: 1144542499
Provider Name (Legal Business Name): STEVEN GROSS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST 5TH FLOOR
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

6141 SAUNDERS ST APT A30
REGO PARK NY
11374-1052
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-737-4876
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: