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General NPI Number Information
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NPI Number | 1558676817
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Entity Type | Individual
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Provider Name | JUSTIN ALLAN GROSS MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 71 W 156TH ST STE 110
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City | HARVEY
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State | IL
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Zip | 60426-4267
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Country | US
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Telephone | 618-319-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 605 W 42ND ST APT 51H
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City | NEW YORK
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State | NY
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Zip | 10036-2099
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Country | US
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Telephone | 701-426-9742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 335607
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 63687
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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