=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073799847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL SHARON GROSS M.D., M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 10/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3444 KOSSUTH AVE FAMILY CARE CENTER, PEDIATRIC PRACTICE C
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-920-2655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 E 94TH ST APT 3E
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-1757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-717-7763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 244772
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------